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SANFORD BEMIDJI INFUSION PHARMACY
DSH240100 Sanford Bemidji Medical Center
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Covered Entity Details
Entity Name
Sanford Bemidji Medical Center
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH240100
Entity Address
1300 ANNE STREET NW
BEMIDJI, MN 56601
Medicare Provider Number
240100
Participating Start Date
10/1/2013
Last Recertification Date
8/22/2024
Pharmacy Details
Pharmacy Name
SANFORD BEMIDJI INFUSION PHARMACY
Pharmacy Address
1233 34TH ST NW STE B
BEMIDJI, MN 56601-5112
Pharmacy Comments
Contract Details
Approval Date
4/15/2014
Contract Begin Date
7/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
8/17/2018
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
CRAIG O. BOYER, Vice President of Finance
(218) 333-5508
Contract Pharmacy Representative
Robert Biberdorf, Director of Pharmacy
(701) 234-5603
Signed By Date
4/15/2014
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