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FAIRVIEW PHARMACY CBCD
HM10193 SANFORD MEDICAL CENTER FARGO
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Covered Entity Details
Entity Name
SANFORD MEDICAL CENTER FARGO
Subdivision Name
SANFORD HEALTH CENTER FOR BLEEDING AND CLOTTING DISORDERS
Type
Comprehensive Hemophilia Treatment Center
340B ID
HM10193
Entity Address
801 Broadway N
FARGO, ND 58102
Grant Number
H30MC24052
Participating Start Date
1/1/1997
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
FAIRVIEW PHARMACY CBCD
Pharmacy Address
2512 S. 7TH ST, SUITE 105
MINNEAPOLIS, MN 55454
Pharmacy Comments
Contract Details
Approval Date
1/17/2024
Contract Begin Date
4/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Tiffany Lawrence, President and CEO, Fargo
(701) 417-2314
Contract Pharmacy Representative
Fairview Specialty Pharmacy
Gene Klun, Hospital and Provider Account Manager
(612) 839-6947
Signed By Date
1/17/2024
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