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DAKOTA CLINIC PHARMACY
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
DAKOTA CLINIC PHARMACY
Pharmacy Address
ON SU DRIVE
1702 UNIVERSITY DR S
FARGO, ND 58103-4940
Pharmacy Comments
Contract Details
Approval Date
4/18/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Kristin Herrmann, Vice President, Finance
(701) 417-2326
Contract Pharmacy Representative
Dakota Clinic Pharmacy
Laura Morris, Owner
(701) 364-3450
Signed By Date
4/18/2023
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