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GATEWAY PHARMACY SUNRISE
RRC350015-00 Sanford Bismarck
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Covered Entity Details
Entity Name
Sanford Bismarck
Subdivision Name
Type
Rural Referral Center
340B ID
RRC350015-00
Entity Address
300 N 7th St
Bismarck, ND 58501
Medicare Provider Number
350015
Participating Start Date
1/1/2013
Last Recertification Date
8/21/2015
Entity Termination Date
7/1/2016
Pharmacy Details
Pharmacy Name
GATEWAY PHARMACY SUNRISE
Pharmacy Address
3103 YORKTOWN DR STE 2
BISMARCK, ND 58503-8527
Pharmacy Comments
Contract Details
Approval Date
4/9/2015
Contract Begin Date
7/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2016
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Kirk Cristy, Vice President Finance
(701) 323-6000 Ext: 6310
Contract Pharmacy Representative
Mark Aurit, Owner
(701) 224-9521
Signed By Date
4/9/2015
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