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WULLSTEIN PHARMACY INC
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
WULLSTEIN PHARMACY INC
Pharmacy Address
DBA BRANDON PHARMACY
116 E HOLLY BLVD
BRANDON, SD 57005
Pharmacy Comments
Contract Details
Approval Date
7/13/2015
Contract Begin Date
10/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/13/2025
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Steve Goetsch, CFO
(605) 328-6940
Contract Pharmacy Representative
Tom Wullstein, Owner/Pharmacist
(605) 582-6000
Signed By Date
7/13/2015
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