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RWII58103 Canopy Medical Clinic (Active)
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Main Details
Name
Canopy Medical Clinic
Subdivision Name
Type
Ryan White Part B
340B ID
RWII58103
Grant Number
X07HA00043
Additional Details
Current Program Status
Active
Registration Date
10/7/2021
Participating Start Date
1/1/2022
Participating Approval Date
11/22/2021
Last Recertification Date
2/21/2025
Time Period the Assistance was Received
6/1/2021 - 1/1/2026
Contacts
Authorizing Official
Canopy Medical Clinic
Heidi Selzler-Echola, Medical Director/APRN
(701) 264-5200
Primary Contact
Canopy Medical Clinic
Michaela Swanston, RN
(701) 264-5200
Addresses
Street Address
1411 32nd St S
Suite 1
Fargo, ND 58103
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
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June 2025
June 2025
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