340B Drug Pricing Program Database
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DSH350011GY SANFORD MEDICAL CENTER FARGO (Active)
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Main Details
Name
SANFORD MEDICAL CENTER FARGO
Subdivision Name
Sanford Medical Center Fargo / Home Dialysis Detroit Lakes 1200.43015 1500100512 - Sanford Medical Center Fargo / Home Dialysis Detroit Lakes 1200.43015 1500100512
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH350011GY
Medicare Provider Number
350011
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
1/15/2021
Participating Start Date
4/1/2021
Participating Approval Date
2/9/2021
Last Recertification Date
9/5/2024
Contacts
Authorizing Official
Sanford Medical Center Fargo
Kristin Herrmann, Vice President, Finance
(701) 417-2326
Primary Contact
Sanford Health
Jesse Breidenbach, Vice President, Pharmacy
(701) 234-6887
Addresses
Street Address
1234 Washington Ave Suite B
Detroit Lakes, MN 56501-3502
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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