340B Drug Pricing Program Database
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DSH430027DS Sanford USD Medical Center (Terminated)
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Main Details
Name
Sanford USD Medical Center
Subdivision Name
SANFORD CARDIOVASCULAR INSTITUTE CLEAR LAKE - SANFORD CARDIOVASCULAR INSTITUTE CLEAR LAKE
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH430027DS
Medicare Provider Number
430027
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/12/2023
Participating Start Date
1/1/2024
Participating Approval Date
11/20/2023
Last Recertification Date
Termination Date
Termination Reason
4/1/2024
Business decision by the Covered Entity
Contacts
Authorizing Official
Sanford Health
Eric Lucas Vanden Hull, Vice President of Finance - Sioux Falls HSD
(712) 261-5275
Primary Contact
Sanford USD Medical Center
Alyssa O Howard, Director of Pharmacy
(605) 695-1697
Addresses
Street Address
701 S 3RD AVE
CLEAR LAKE, SD 57226
Billing Address
SANFORD USD MEDICAL CENTER
1305 W 18TH STREET
SIOUX FALLS, SD 57117-5039
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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