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SANFORD MEDICAL CENTER
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
SANFORD MEDICAL CENTER
Pharmacy Address
DBA SANFORD CANCER CENTER ONCOLOGY CLINI
1309 W 17TH ST STE 101
SIOUX FALLS, SD 57104-8805
Pharmacy Comments
Contract Details
Approval Date
3/12/2013
Contract Begin Date
4/1/2013
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/28/2021
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Michelle Bruhn, CFO
(605) 333-6450
Contract Pharmacy Representative
Bryan Nermoe, COO
(605) 328-6942
Signed By Date
1/14/2013
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