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FAIRVIEW PHARMACY CBCD
DSH430027 Sanford USD Medical Center
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Covered Entity Details
Entity Name
Sanford USD Medical Center
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH430027
Entity Address
1305 W 18th Street
Sioux Falls, SD 57117-5039
Medicare Provider Number
430027
Participating Start Date
1/1/2013
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
FAIRVIEW PHARMACY CBCD
Pharmacy Address
2512 S. 7TH ST, SUITE 105
MINNEAPOLIS, MN 55454
Pharmacy Comments
Contract Details
Approval Date
1/18/2023
Contract Begin Date
4/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Eric Lucas Vanden Hull, Vice President of Finance - Sioux Falls HSD
(712) 261-5275
Contract Pharmacy Representative
Fairview
Tim Affeldt, VP of Specialty/Infusion Operations
(612) 672-5127
Signed By Date
1/18/2023
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