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ARJ INFUSION SERVICES, LLC
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
ARJ INFUSION SERVICES, LLC
Pharmacy Address
3730 S 149TH ST
STE. 102
OMAHA, NE 68144
Pharmacy Comments
Contract Details
Approval Date
1/17/2023
Contract Begin Date
4/1/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/16/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Tiffany Lawrence, President and CEO, Fargo
(701) 417-2314
Contract Pharmacy Representative
ARJ Infusion
Mitchell Clevenger, Vice President, Business Development
(913) 702-6250
Signed By Date
1/17/2023
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