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LEWIS DRUG #10
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
LEWIS DRUG #10
Pharmacy Address
6109 S LOUISE AVE
SIOUX FALLS, SD 57108
Pharmacy Comments
4/19/11 CORRECTED ADDR (WAS 3109 S. LOUISE AVENUE)
Contract Details
Approval Date
3/13/2013
Contract Begin Date
4/1/2013
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Michelle Bruhn, CFO
(605) 333-6450
Contract Pharmacy Representative
Lewis Drug
Scott Cross, EVP
(605) 367-2800
Signed By Date
1/15/2013
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