Contract Pharmacy Details

WALGREEN CO.
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

WALGREEN CO.

Pharmacy Address

WALGREENS SPECIALTY PHARMACY #15309
2100 LYNDALE AVE S STE A
MINNEAPOLIS, MN 55405

Pharmacy Comments

Contract Details

Approval Date

7/14/2022

Contract Begin Date

10/1/2022

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

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

Contract Pharmacy Representative

Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663

Signed By Date

7/14/2022

340B Drug Pricing Program Database