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ND PHARMACY WEST
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
ND PHARMACY WEST
Pharmacy Address
1283 ROUGHRIDER BLVD
DICKINSON, ND 58601
Pharmacy Comments
Contract Details
Approval Date
4/11/2022
Contract Begin Date
4/21/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Kirk Cristy, Vice President Finance
(701) 323-6000 Ext: 6310
Contract Pharmacy Representative
ND Pharmacy Inc
Robert Treitline, Pharmacy Owner
(701) 225-4434
Signed By Date
4/11/2022
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