Contract Pharmacy Details

WALLS ALTRU PHARM INC D/B/A WALLS HEALTH
DSH350011 SANFORD MEDICAL CENTER FARGO

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

WALLS ALTRU PHARM INC D/B/A WALLS HEALTH

Pharmacy Address

4440 S WASHINGTON ST STE 101-D
GRAND FORKS, ND 58201-7245

Pharmacy Comments

Contract Details

Approval Date

4/15/2022

Contract Begin Date

7/1/2022

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

11/23/2022
Pharmacy closed

Contacts

Covered Entity Signing Official

Tiffany Lawrence, President and CEO, Fargo
(701) 417-2314

Contract Pharmacy Representative

Prairie Pharmacy FA1
Dennis Johnson, Owner
(701) 314-0056

Signed By Date

4/15/2022

340B Drug Pricing Program Database