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AMERICAN DRUG STORES DELAWARE, L.L.C.
DSH350015 SANFORD BISMARCK
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Covered Entity Details
Entity Name
SANFORD BISMARCK
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH350015
Entity Address
300 N 7TH ST
BISMARCK, ND 58501
Medicare Provider Number
350015
Participating Start Date
7/1/2016
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
AMERICAN DRUG STORES DELAWARE, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 08611
1520 20TH AVE SW
MINOT, ND 58701
Pharmacy Comments
Contract Details
Approval Date
1/20/2020
Contract Begin Date
4/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Kirk Cristy, Vice President Finance
(701) 323-6000 Ext: 6310
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
1/20/2020
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