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NUCARA PHARMACY #35
DSH350011 SANFORD MEDICAL CENTER FARGO
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Covered Entity Details
Entity Name
SANFORD MEDICAL CENTER FARGO
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH350011
Entity Address
801 BROADWAY NORTH
FARGO, ND 58102
Medicare Provider Number
350011
Participating Start Date
4/1/2017
Last Recertification Date
8/20/2024
Pharmacy Details
Pharmacy Name
NUCARA PHARMACY #35
Pharmacy Address
NUDAK VENTURES NORTH DAKOTA, LLC
308 RAILWAY ST
NUDAK VENTURES NORTH DAKOTA LLC
ENDERLIN, ND 58027-1344
Pharmacy Comments
Contract Details
Approval Date
4/5/2022
Contract Begin Date
7/1/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/31/2022
Pharmacy closed
Contacts
Covered Entity Signing Official
Tiffany Lawrence, President and CEO, Fargo
(701) 417-2314
Contract Pharmacy Representative
Nudak Ventures LLC
Lori Willis, Acquisitions Manager
(641) 366-3440 Ext: 127
Signed By Date
4/5/2022
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