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THRIFTY WHITE PHARMACY #005
DSH350015 SANFORD BISMARCK
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Covered Entity Details
Entity Name
SANFORD BISMARCK
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH350015
Entity Address
300 N 7TH ST
BISMARCK, ND 58501
Medicare Provider Number
350015
Participating Start Date
7/1/2016
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
THRIFTY WHITE PHARMACY #005
Pharmacy Address
707 SOUTH 3RD ST
BISMARCK, ND 58504
Pharmacy Comments
Contract Details
Approval Date
5/13/2016
Contract Begin Date
7/1/2016
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Kirk Cristy, Vice President Finance
(701) 323-6000 Ext: 6310
Contract Pharmacy Representative
THRIFTY WHITE
Alicia Hager, Pharmacy Operations Specialist
(763) 463-4482
Signed By Date
5/13/2016
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