340B Drug Pricing Program Database


DSH430016 AVERA MCKENNAN (Active) - information as of 4/25/2025 6:32:21 PM

Main Details
AVERA MCKENNAN
Disproportionate Share Hospital
Yes
DSH430016
430016


Additional Details
Active
9/17/2008
9/18/2008
9/18/2008
9/5/2024

Contacts

Avera
Melissa Goff, Vice President - Pharmacy
(605) 322-8548

Avera
Brandy Friesen, Pharmacy Regulatory Analyst
(605) 322-8446

Addresses

1325 S. CLIFF AVE.
SIOUX FALLS, SD 57105

Avera McKennan Hospital
PO BOX 5045
Sioux Falls, SD 57117


  • Comments
  • Medicaid Billing
  • Shipping Addresses
  • Contract Pharmacies
  • Parent/Child
  • History
Comments
CommentLast Updated On 
8/17/11 ADDED NPI #; 7/8/11 UPDATED ZIP (WAS 57117); 8/31/09 - DOC RECD TO CONFIRM ELIG DSH ADJ %;05/05/11 UPDATED ADDR.(WAS 800 EAST 21ST STREET)08/17/2011
7/8/11 UPDATED ZIP (WAS 57117); 8/31/09 - DOC RECD TO CONFIRM ELIG DSH ADJ %;05/05/11 UPDATED ADDR.(WAS 800 EAST 21ST STREET)07/08/2011
Medicaid Billing

No
Shipping Addresses

AVERA DERMATOLOGY PHARMACY
6701 S. MINNESOTA AVE
SIOUX FALLS, SD 57108

AVERA SPECIALTY PHARMACY
500 E 56TH ST N
STE 3150
SIOUX FALLS, SD 57104

AVERA DISTRIBUTION CENTER
3301 N 1ST AVE
SIOUX FALLS, SD 57104

Avera 7th Avenue Pharmacy
1200 S. 7TH AVENUE
SUITE 101
Sioux Falls, SD 57105

AVERA 69TH STREET PHARMACY
4400 W 69TH STREET
SUITE 300
SIOUX FALLS, SD 57108-0000

AVERA MCKENNAN CAMPUS PHARMACY
1325 S CLIFF AVE
STE CP
SIOUX FALLS, SD 57105-1008

Avera McKennan Hospital
1325 S Cliff Avenue
Sioux Falls, SD 57105

Avera on Louise Pharmacy
6100 S Louise Ave
Suite 1100
Sioux Falls, SD 57108

Avera Long-Term Care Pharmacy
4101 W. Memory Cr. Ste 120
Sioux Falls, SD 57107-0000

Avera Central Distribution
4101 W Memory Circle, Ste 150
Sioux Falls, SD 57107

Avera on Louise Inpatient Pharmacy
6100 S. Louise Ave.
STE B300
Sioux Falls, SD 57108

Avera Plaza 2 Pharmacy
1301 S Cliff Ave Ste 225
Sioux Falls, SD 57105

Safecor
4060 Business Park Dr Ste B
Columbus, OH 43204-5047

AVERA MCKENNAN HOME INFUSION PHARMACY
1020 S CLIFF AVE
SIOUX FALLS, SD 57104
Contract Pharmacies
Contract DetailPharmacy NameAddressAddress Cont.CityStateZip CodeApproval DateBegin DateCarve-In Effective DateTermination DateLast Updated On
Contract DetailACCREDO HEALTH GROUP INC3000 ERICSSON DRIVE, SUITE 100
WARRENDALEPA15086-750201/11/201804/01/2018  01/11/2018
Contract DetailACCREDO HEALTH GROUP INC1620 CENTURY CENTER PKWY # 109
MEMPHISTN38134-884901/11/201804/01/2018  01/11/2018
Contract DetailACCREDO HEALTH GROUP INC2040 W RIO SALADO PKWY STE 101B
TEMPEAZ85281-201001/11/201804/01/2018  01/11/2018
Contract DetailACCREDO HEALTH GROUP, INC.2825 W PERIMETER RD STE 112
INDIANAPOLISIN4624101/11/201804/01/2018 05/30/202306/12/2023
Contract DetailACCREDO HEALTH GROUP, INC.4750 E 450 S SUITE A
WHITESTOWNIN4607504/18/202307/01/2023  07/01/2023
Contract DetailADVANCED CARE SCRIPTS, INCCVS/SPECIALTY OR CARELONRX SPECIALTY PHA 6251 CHANCELLOR DRIVE
SUITE 101 		ORLANDOFL3280910/12/201701/01/2018  10/12/2017
Contract DetailAMBER ENTERPRISES, INCDBA AMBER SPECIALTY PHARMACY 10004 S 152ND ST STE A
OMAHANE68138-393107/18/201610/01/2016 07/01/201608/03/2017
Contract DetailAMBER ENTERPRISES, INCDBA AMBER SPECIALTY PHARMACY 10004 S 152ND ST STE A
OMAHANE68138-393101/17/201704/01/2017  08/03/2017
Contract DetailASTRUP DRUG INCSTERLING DRUG #8 511 10TH ST.
WORTHINGTONMN5618707/17/202310/01/2023  10/01/2023
Contract DetailAVERA GRASSLAND PHARMACY1900 GRASSLAND DR STE 101
MITCHELLSD5730104/14/202407/01/2024  07/01/2024
Contract DetailAVERA LONG-TERM CARE PHARMACYAVERA MCKENNAN 4101 W MEMORY CIR STE 120
SIOUX FALLSSD5710710/15/201501/01/2016 12/14/201508/03/2017
Contract DetailAVERA MCKENNANDBA AVERA DERMATOLOGY PHARMACY 6701 S. MINNESOTA AVE
SIOUX FALLSSD5710808/09/201108/09/2011 12/07/201812/14/2018
Contract DetailAVERA MCKENNANDBA AVERA 69TH STREET PHARMACY 4400 W 69TH ST STE 300
SIOUX FALLSSD57108-817011/07/201111/07/2011 12/07/201812/14/2018
Contract DetailAVERA MCKENNAN CAMPUS PHARMACY1325 S CLIFF AVE STE CP
SIOUX FALLSSD57105-100803/04/200903/04/2009 12/07/201812/14/2018
Contract DetailAVERA MCKENNAN HOME INFUSION1020 S CLIFF AVE
SIOUX FALLSSD5710407/09/201510/01/2015 12/07/201812/14/2018
Contract DetailAVERA SPECIALTY PHARMACY500 E 56TH ST N STE 3150
SIOUX FALLSSD5710407/09/201510/01/2015 12/07/201812/14/2018
Contract DetailAVERA ST. MARY'S CAMPUS PHARMAVERA ST. MARY'S 100 MAC LN STE 101
PIERRESD57501-339301/07/202004/01/2020  04/01/2020
Contract DetailAVERA STATE STREET PHARMACYAVERA ST. LUKE'S 105 S STATE ST STE 101
ABERDEENSD57401-450107/15/202210/01/2022  10/01/2022
Contract DetailBIOPLUS SPECIALTY PHARMACY SERVICES, LLC13925 YALE AVE STE 145
IRVINECA92620-267007/17/202310/01/2023  10/01/2023
Contract DetailBIOPLUS SPECIALTY PHARMACY SERVICES, LLC376 NORTHLAKE BLVD
ALTAMONTE SPRINGSFL32701-526107/17/202310/01/2023  10/01/2023
Contract DetailBIOPLUS SPECIALTY PHARMACY SERVICES, LLC4900 PROSPECTUS DR STE 300
DURHAMNC2771307/17/202310/01/2023  10/01/2023
Contract DetailBRIOVARX OF MAINE INCDBA BRIOVARX 53 DARLING AVE
SOUTH PORTLANDME0410604/10/201807/01/2018 10/01/201911/06/2019
Contract DetailBRIOVARX OF MASSACHUSETTS, LLCD/B/A BRIOVARX BLDG 2 - UNIT A
145 BODWELL STREET 		AVONMA0232204/10/201807/01/2018 10/01/201911/06/2019
Contract DetailCAREMARK FLORIDA SPECIALTY PHARMACY LLCDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 7930 WOODLAND CENTER BLVD STE 500
TAMPAFL3361407/15/202010/01/2020  10/01/2020
Contract DetailCAREMARK ILLINOIS SPECIALTY PHARMACY, LLDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 800 BIERMANN CT STE B
MOUNT PROSPECTIL6005601/17/201704/01/2017  08/03/2017
Contract DetailCAREMARK KANSAS SPECIALTY PHARMACYCVS/SPECIALTY OR CARELONRX SPECIALTY PHA 11162 RENNER BLVD
LENEXAKS6621901/17/201704/01/2017  08/03/2017
Contract DetailCAREMARK MASSACHUSETTS SPECIALTY PHARMACDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 25 BIRCH STREET, BLDG B, SUITE 100
MILFORDMA0175707/15/202010/01/2020  10/01/2020
Contract DetailCAREMARK MICHIGAN SPECIALTY PHARMACY, LLDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 1307 ALLEN DR STE H
TROYMI4808307/15/202010/01/2020  10/01/2020
Contract DetailCAREMARK NEW JERSEY SPECIALTY PHCY, LLCDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 180 PASSAIC AVE UNIT B-5
FAIRFIELDNJ0700401/17/201704/01/2017  08/03/2017
Contract DetailCAREMARK NORTH CAROLINA SPECIALTY PHARMADBA CVS/SPECIALTY OR CARELONRX SPECIALTY 10700 WORLD TRADE BLVD STE 110
RALEIGHNC2761707/15/202010/01/2020  10/01/2020
Contract DetailCAREMARK PUERTO RICO SPECIALTY PHARMACY,CAREMARK PUERTO RICO SPECIALTY PHARMACY 6020 AVE ROBERTO SANCHEZ VILELLA
CAROLINAPR0098207/15/202010/01/2020 07/01/202207/15/2022
Contract DetailCAREMARK TENNESSEE SPECIALTY PHARMACY, LDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 8370 WOLF LAKE DR
STE 107 		BARTLETTTN3813307/15/202010/01/2020  10/01/2020
Contract DetailCAREMARK, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 1127 BRYN MAWR AVE
SUITE A 		REDLANDSCA9237401/17/201704/01/2017  08/03/2017
Contract DetailCAREMARK, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 7251 S. EASTERN AVE.
LAS VEGASNV8911907/15/202010/01/2020  10/01/2020
Contract DetailCORAM ALTERNATE SITE SERVICES, INC.DBA CORAM CVS/SPECIALTY INFUSION SERVICE 11111 MILL VALLEY RD
OMAHANE68154-393310/14/202101/01/2022 06/28/202409/09/2024
Contract DetailCVS CAREMARKDBA CVS/CAREMARK OR CF# 11506 1 GREAT VALLEY BOULEVARD
WILKES BARREPA1870604/15/202107/01/2021  07/01/2021
Contract DetailCVS CAREMARK ADVANCED TECHNOLOGY PHARMACDBA CVS/CAREMARK 48067 1780 WALL ST
MT PROSPECTIL6005604/15/202107/01/2021  07/01/2021
Contract DetailCVS PHARMACY, INC.CVS PHARMACY # 16018 3600 S LOUISE AVE
SIOUX FALLSSD5710604/06/201707/01/2017  08/03/2017
Contract DetailCVS PHARMACY, INC.CVS PHARMACY # 17566 1021 S HIGHLINE PL
SIOUX FALLSSD5711004/06/201707/01/2017  08/03/2017
Contract DetailCVS PHARMACY, INC.CVS PHARMACY # 17510 1415 EGLIN ST
RAPID CITYSD5770110/07/202001/01/2021  01/01/2021
Contract DetailCVS/SPECIALTY OR CARELONRX SPECIALTY PHACAREMARK, LLC 1001 SPINKS ROAD, STE 280
FLOWER MOUNDTX7502807/15/202010/01/2020  10/01/2020
Contract DetailCYSTIC FIBROSIS SERVICES, LLCDBA WALGREENS SPECIALTY PHARMACY #16280 10530 JOHN W ELLIOTT DR STE 200
FRISCOTX7503301/08/202004/01/2020  04/01/2020
Contract DetailDAN'S DRUGSTORE5028 S CLIFF AVE
SIOUX FALLSSD57108-543207/15/201610/01/2016 06/01/202306/26/2023
Contract DetailDIPLOMAT SPECIALTY PHARMACY4100 S SAGINAW ST STE D
FLINTMI48507-268307/15/202010/01/2020 12/30/202206/14/2023
Contract DetailDOGWOOD PHARMACY, INCD/B/A MEDSCRIPTS MEDICAL PHARMACY 1325 MILLER ROAD
SUITE K 		GREENVILLESC29607-654007/17/202310/01/2023  10/01/2023
Contract DetailFAIRVIEW SPECIALTY SERVICES PHARMACY711 KASOTA AVENUE SE, SUITE A
MINNEAPOLISMN5541404/13/201807/01/2018  04/13/2018
Contract DetailHY-VEE CLINIC 16281012 OKOBOJI AVE
MILFORDIA5135104/11/202507/01/2025  04/11/2025
Contract DetailHY-VEE FOOD STORESDBA HY-VEE PHARMACY 4101 S LOUISE AVE
SIOUX FALLSSD5710609/12/201109/12/2011  08/03/2017
Contract DetailHY-VEE FOOD STORESHY-VEE PHARMACY 1221 CENTRAL AVENUE
ESTHERVILLEIA5133404/11/202507/01/2025  04/11/2025
Contract DetailHY-VEE FOOD STORES INCHY-VEE PHARMACY #3 (1632) 3000 S MINNESOTA AVE
SIOUX FALLSSD5710509/12/201109/12/2011  08/03/2017
Contract DetailHY-VEE PHARMACY1951 S MAIN
SIOUX CENTERIA5125004/11/202507/01/2025  04/11/2025
Contract DetailHY-VEE PHARMACY1500 18TH STREET
SPIRIT LAKEIA5136004/11/202507/01/2025  04/11/2025
Contract DetailHY-VEE PHARMACY #16241601 S SYCAMORE DR
SIOUX FALLSSD5711009/12/201109/12/2011  08/03/2017
Contract DetailHY-VEE PHARMACY #16373020 EAST 10TH
SIOUX FALLSSD5710309/12/201109/12/2011  08/03/2017
Contract DetailHY-VEE PHARMACY #18992100 BROADWAY AVE
YANKTONSD5707804/11/202507/01/2025  04/11/2025
Contract DetailHY-VEE PHARMACY #6 (1638)1231 E 57TH STREET
SIOUX FALLSSD5710809/28/201109/28/2011  08/03/2017
Contract DetailHY-VEE PHARMACY (#1039)790 22ND AVE SOUTH
BROOKINGSSD5700609/12/201109/12/2011  08/03/2017
Contract DetailHY-VEE PHARMACY (1382)1201 12TH AVE SW
LE MARSIA5103104/11/202507/01/2025  04/11/2025
Contract DetailHY-VEE PHARMACY (1633)1900 SOUTH MARION ROAD
SIOUX FALLSSD5710609/12/201109/12/2011  08/03/2017
Contract DetailHY-VEE PHARMACY (1636)819 GRAND
SPENCERIA5130104/11/202507/01/2025  04/11/2025
Contract DetailHY-VEE PHARMACY FULFILLMENT CENTER 4016HY-VEE INC 4707 FLUER DR
DES MOINESIA5032110/28/201301/01/2014 12/16/201508/03/2017
Contract DetailHY-VEE PHARMACY SOLUTIONSHYVACS, LLC 10004 S. 152ND ST., SUITE C
OMAHANE6813810/05/201601/01/2017 10/01/201608/03/2017
Contract DetailHY-VEE PHARMACY SOLUTIONSHYVACS, LLC 10004 S. 152ND ST., SUITE C
OMAHANE6813801/17/201704/01/2017  08/03/2017
Contract DetailHY-VEE, INC.DBA: HY-VEE PHARMACY #1639 2700 W 10TH STREET
SIOUX FALLSSD5710409/28/201109/28/2011 12/31/202104/14/2022
Contract DetailHY-VEE, INC.1320 9TH AVE SE
WATERTOWNSD5720110/14/201901/01/2020  01/01/2020
Contract DetailHY-VEE, INC.DBA: HY-VEE PHARMACY 1897 1235 OXFORD STREET
WORTHINGTONMN5618707/07/202110/01/2021  10/01/2021
Contract DetailHY-VEE, INC.HY-VEE PHARMACY (3633) 304 W HWY 38 SUITE 102
HARTFORDSD5703307/07/202110/01/2021  10/01/2021
Contract DetailHY-VEE, INC.HY-VEE CLINIC PHARMACY (1400) 1420 E COLLEGE DR.
MARSHALLMN5625804/11/202507/01/2025 04/15/202504/25/2025
Contract DetailHY-VEE, INC.HY-VEE PHARMACY 1573 1989 PARK ST.
PO BOX 408 		SHELDONIA5120104/11/202507/01/2025  04/11/2025
Contract DetailK MART PHARMACY  3020 W 12TH STREET
SIOUX FALLSSD5710404/11/201407/01/2014 01/21/201708/03/2017
Contract DetailK MART PHARMACY #7306  3709 EAST 10TH STREET
SIOUX FALLSSD5710304/11/201407/01/2014 09/30/201608/03/2017
Contract DetailLEWIS DRUG #12901 S MINNESOTA AVE
SIOUX FALLSSD5710503/09/201103/09/2011  08/03/2017
Contract DetailLEWIS DRUG #106109 S LOUISE AVE
SIOUX FALLSSD5710803/09/201103/09/2011  08/03/2017
Contract DetailLEWIS DRUG #111301 E 10TH ST SUITE 100
SIOUX FALLSSD5710303/09/201103/09/2011  08/03/2017
Contract DetailLEWIS DRUG #12910 22ND AVE S
BROOKINGSSD57006-283003/09/201103/09/2011  08/03/2017
Contract DetailLEWIS DRUG #13720 E 1ST ST
TEASD5706403/09/201103/09/2011  08/03/2017
Contract DetailLEWIS DRUG #14LEWIS DRUG INC 136 S PHILLIPS AVE
SIOUX FALLSSD5710407/07/202110/01/2021  10/01/2021
Contract DetailLEWIS DRUG #15LEWIS DRUGS, INC. 2525 S ELLIS RD
SIOUX FALLSSD57106-706604/12/201907/01/2019  07/01/2019
Contract DetailLEWIS DRUG #22700 W 12TH ST
SIOUX FALLSSD57104-370103/09/201103/09/2011  08/03/2017
Contract DetailLEWIS DRUG #31301 E 10TH ST
SIOUX FALLSSD57103-178003/09/201103/09/2011  08/03/2017
Contract DetailLEWIS DRUG #41950 DAKOTA AVE S
HURONSD57350-402603/09/201103/09/2011  08/03/2017
Contract DetailLEWIS DRUG #5741 S WASHINGTON AVE
MADISONSD57042-340903/09/201103/09/2011  08/03/2017
Contract DetailLEWIS DRUG #65500 W 41ST ST
SIOUX FALLSSD57106-100903/09/201103/09/2011  08/03/2017
Contract DetailLEWIS DRUG #74409 E 26TH ST
SIOUX FALLSSD5710303/09/201103/09/2011  08/03/2017
Contract DetailLEWIS DRUG #9115 SPLITROCK BLVD PO BOX 527
BRANDONSD5700503/09/201103/09/2011  08/03/2017
Contract DetailLEWIS DRUG DISTRIBUTION CENTER700 E 54TH ST N
SIOUX FALLSSD5710404/05/201104/05/2011  08/03/2017
Contract DetailLEWIS FAMILY DRUG #51202 S KNISS AVE
LUVERNEMN56156-177503/09/201103/09/2011  08/03/2017
Contract DetailLEWIS FAMILY DRUG #53LEWIS FAMILY DRUG, LLC 1002 N HIGHWAY 77
DELL RAPIDSSD5702203/09/201103/09/2011  08/03/2017
Contract DetailLEWIS FAMILY DRUG #54LEWIS FAMILY DRUG LLC 2202 17TH ST
SPIRIT LAKEIA5136003/09/201103/09/2011  08/03/2017
Contract DetailLEWIS FAMILY DRUG #56LEWIS FAMILY DRUG, LLC 599 2ND AVE N
WINDOMMN56101-192703/09/201103/09/2011  08/03/2017
Contract DetailLEWIS FAMILY DRUG #59LEWIS FAMILY DRUG, LLC 143 S MAIN AVE
SIOUX CENTERIA51250-153503/09/201103/09/2011  08/03/2017
Contract DetailLEWIS FAMILY DRUG #60LEWIS FAMILY DRUG, LLC 715 E 5TH ST
PO BOX 291 		CANTONSD57013-182903/09/201103/09/2011  08/03/2017
Contract DetailLEWIS FAMILY DRUG #61LEWIS FAMILY DRUG LLC 106 N BOONE ST
ROCK RAPIDSIA51246-153703/09/201103/09/2011  08/03/2017
Contract DetailLEWIS FAMILY DRUG #63515 N PINE ST
LENNOXSD57039-218803/09/201103/09/2011  08/03/2017
Contract DetailLEWIS FAMILY DRUG #65LEWIS FAMILY DRUG, LLC 6110 S MINNESOTA AVE.
SIOUX FALLSSD5710803/09/201103/09/2011 10/12/202310/13/2023
Contract DetailLEWIS FAMILY DRUG #66911 W CEDAR ST STE 1
BERESFORDSD57004-160803/09/201103/09/2011  08/03/2017
Contract DetailLEWIS FAMILY DRUG #67LEWIS FAMILY DRUG LLC 420 2ND AVE
SIBLEYIA51249-120504/15/202304/25/2023  04/25/2023
Contract DetailLEWIS FAMILY DRUG #68111 CALUMET AVE SW
DE SMETSD5723103/09/201103/09/2011  08/03/2017
Contract DetailLEWIS FAMILY DRUG #691227 VALLEY DR
ROCK VALLEYIA51247-155203/09/201103/09/2011  08/03/2017
Contract DetailLEWIS FAMILY DRUG #70LEWIS FAMILY DRUG, LLC 127 E 2ND AVE.
FLANDREAUSD5702803/09/201103/09/2011  08/03/2017
Contract DetailLEWIS FAMILY DRUG #711507 N MAIN ST
MITCHELLSD57301-101704/12/201907/01/2019  07/01/2019
Contract DetailLEWIS FAMILY DRUG #721305 W HAVENS AVE
MITCHELLSD57301-411604/12/201907/01/2019  07/01/2019
Contract DetailMAIN STREET PHARMACY I, CORP.DBA NORM'S THRIFTY WHITE PHARMACY 389 S. MAIN ST.
PO BOX 120 		FREEMANSD57029-012010/12/201701/01/2018 01/01/202306/14/2023
Contract DetailOPTUM FRONTIER THERAPIES II, LLC6425 SANTA MARGARITA ST UNIT 110
LAS VEGASNV89118-191304/10/201807/01/2018 10/23/202001/22/2021
Contract DetailOPTUM PHARMACY 701, LLC8131 W BOSTIAN RD STE A350
WOODINVILLEWA98072-502904/14/202107/01/2021  07/01/2021
Contract DetailOPTUM PHARMACY 701, LLC4100 S SAGINAW ST STE D
FLINTMI4850704/14/202204/15/2022  04/21/2022
Contract DetailOPTUM PHARMACY 701, LLC1830 S HORNE
MESAAZ8520401/13/202504/01/2025  04/01/2025
Contract DetailOPTUM PHARMACY 702, LLC1050 PATROL RD
JEFFERSONVILLEIN4713004/10/201807/01/2018  04/10/2018
Contract DetailOPTUM PHARMACY 705, LLC1100 LEE BRANCH LN
BIRMINGHAMAL35242-729804/10/201807/01/2018  04/10/2018
Contract DetailOPTUM PHARMACY 706, INC.30-30 47TH AVENUE SUITE 410
LONG ISLAND CITYNY1110104/10/201807/01/2018  04/10/2018
Contract DetailOPTUM PHARMACY 801, INC.24416 N 19TH AVE STE. 100
PHOENIXAZ8508507/15/202010/01/2020  10/01/2020
Contract DetailOPTUMRX2858 LOKER AVE E STE 100
CARLSBADCA92010-660807/15/202010/01/2020 07/01/202207/15/2022
Contract DetailOPTUMRXOPTUMRX INC 6800 W 115TH ST STE 600
OVERLAND PARKKS66211-983807/15/202010/01/2020  10/01/2020
Contract DetailPHARMERICA1507 W 51ST ST
SIOUX FALLSSD5710507/15/202010/01/2020  10/01/2020
Contract DetailPREMIER PHARMACY SERVICES410 CLOVERLEAF DR
BALDWIN PARKCA9170607/15/201810/01/2018 02/29/202402/29/2024
Contract DetailPRIME THERAPEUTICS SPECIALTY PHARMACY LLALLIANCERX WALGREENS PRIME #16568 2354 COMMERCE PARK DRIVE
SUITE 100 		ORLANDOFL32819-999201/08/202004/01/2020 04/13/202304/13/2023
Contract DetailPROCARE PHARMACY DIRECT, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 105 MALL BOULEVARD
MONROEVILLEPA1514601/17/201704/01/2017  08/03/2017
Contract DetailPROCARE PHARMACY, L.L.C.DBA CVS/PHARMACY #2923 3250 HARDEN ST. EXT. SUITE #300
COLUMBIASC2920307/15/202010/01/2020  10/01/2020
Contract DetailPROCARE PHARMACY, L.L.C.DBA: CVS/PHARMACY #2909 1521 4TH AVE., SOUTH
BIRMINGHAMAL3523307/15/202010/01/2020  10/01/2020
Contract DetailPROCARE PHARMACY, L.L.C.DBA CVS/PHARMACY OR CARELONRX SPECIALTY ONE WATERFRONT PLAZA
500 ALA MOANA BLVD., BLDG 1 		HONOLULUHI9681307/15/202010/01/2020  10/01/2020
Contract DetailPROCARE PHARMACY, L.L.C.DBA CVS/PHARMACY #102 2101 N URSULA STREET UNIT 35
AURORACO80045-742610/07/202001/01/2021  01/01/2021
Contract DetailRAINA RX LLCDBA ROUTE 300 PHARMACY 1208 ROUTE 300
SUITE 103 		NEWBURGHNY1255007/17/202310/01/2023  10/01/2023
Contract DetailRIVER MEDICAL PHARMACY LLC4752 RESEARCH DR
SAN ANTONIOTX78240-500207/17/202310/01/2023  10/01/2023
Contract DetailSALEM COMMUNITY DRUG300 N MAIN ST PO BOX 316
SALEMSD5705807/17/202310/01/2023  10/01/2023
Contract DetailSANTA BARBARA SPECIALTY PHARMACYSANTA BARBARA SPECIALTY PHARMACY LLC DBA 4690 CARPINTERIA AVE STE B
CARPINTERIACA93013-187507/17/202310/01/2023  10/01/2023
Contract DetailSENDERRA RX PHARMACYSENDERRA RX PARTNERS, LLC 3712 E PLANO PKWY STE 200
PLANOTX7507404/12/201907/01/2019 07/06/202301/16/2024
Contract DetailSHOPKO PHARMACY #20761601 WEST 41 STREET
SIOUX FALLSSD5710504/14/201407/01/2014 12/11/201804/12/2019
Contract DetailSHOPKO PHARMACY #21014501 EAST ARROWHEAD PARKWAY
SIOUX FALLSSD57110-270104/14/201407/01/2014 12/11/201804/12/2019
Contract DetailSTATE STREET PHARMACY105 S STATE ST STE 111
ABERDEENSD57401-450204/07/202007/01/2020 02/09/202206/14/2023
Contract DetailVAN HOVE PRESCRIPTION SHOP1200 SOUTH 7TH AVE
SIOUX FALLSSD5710504/15/201307/01/2013 12/18/201712/28/2017
Contract DetailWAL-MART CENTRAL FILL 10-2670608 SPRING HILL DR # 3 SUITE 300
SPRINGTX7738601/08/202004/01/2020  04/01/2020
Contract DetailWAL-MART PHARMACY 10-15353209 SOUTH LOUISE
SIOUX FALLSSD5710607/11/201410/01/2014  08/03/2017
Contract DetailWAL-MART PHARMACY 10-15382233 6TH STREET
BROOKINGSSD5700607/11/201410/01/2014  08/03/2017
Contract DetailWAL-MART PHARMACY 10-32375521 EAST ARROWHEAD PARKWAY
SIOUX FALLSSD5711007/11/201410/01/2014  08/03/2017
Contract DetailWAL-MART PHARMACY 10-59979600 PARKSOUTH CT. SUITE 100
ORLANDOFL3283701/08/202004/01/2020  04/01/2020
Contract DetailWALGREEN CO.DBA: WALGREENS # 10347 901 S BURR STREET
MITCHELLSD57301-473107/15/202010/01/2020  10/01/2020
Contract DetailWALGREEN CO.DBA: WALGREENS # 10572 100 E SIOUX AVE
PIERRESD57501-319607/15/202010/01/2020  10/01/2020
Contract DetailWALGREEN CO.DBA: WALGREENS # 05242 4900 S CLIFF AVE.
SIOUX FALLSSD5710807/15/202010/01/2020  10/01/2020
Contract DetailWALGREEN CO.DBA: WALGREENS # 09806 2020 BROADWAY AVE
YANKTONSD5707807/15/202010/01/2020  10/01/2020
Contract DetailWALGREEN CO.DBA: WALGREENS # 05745 3620 W 41ST STREET
SIOUX FALLSSD5710607/15/202010/01/2020  10/01/2020
Contract DetailWALGREEN CO.DBA: WALGREENS # 10007 421 9TH AVE SE
WATERTOWNSD5720107/15/202010/01/2020  10/01/2020
Contract DetailWALGREEN CO.DBA: WALGREENS # 05514 1806 S MINNESOTA AVENUE
SIOUX FALLSSD57105-281107/15/202010/01/2020  10/01/2020
Contract DetailWALGREEN CO.DBA: WALGREENS # 11153 800 GRAND AVE
SPENCERIA51301-363107/15/202010/01/2020  10/01/2020
Contract DetailWALGREEN CO.WALGREENS #10729 7120 W. 41ST ST.
SIOUX FALLSSD57106-600607/15/202010/01/2020  10/01/2020
Contract DetailWALGREEN CO.DBA: WALGREENS # 01975 1720 S SYCAMORE AVE
SIOUX FALLSSD57110-420707/15/202010/01/2020  10/01/2020
Contract DetailWALGREEN CO.DBA: WALGREENS # 10189 1321 OXFORD ST
WORTHINGTONMN56187-176107/15/202010/01/2020  10/01/2020
Contract DetailWALGREEN CO.DBA: WALGREENS # 05243 2605 W 12TH ST
SIOUX FALLSSD5710407/15/202010/01/2020  10/01/2020
Contract DetailWALGREENS SPECIALTY PHARMACY, LLCDBA WALGREENS SPECIALTY PHARMACY #15438 41460 HAGGERTY CIR S
CANTONMI4818801/08/202004/01/2020  04/01/2020
Contract DetailWALGREENS SPECIALTY PHARMACY, LLCALLIANCERX WALGREENS PRIME #12314 9775 SW GEMINI DR, STE 1
BEAVERTONOR9700801/08/202004/01/2020 04/13/202304/13/2023
Contract DetailWALGREENS SPECIALTY PHARMACY, LLCDBA WALGREENS SPECIALTY PHARMACY #15443 10530 JOHN W ELLIOTT DR STE 100
FRISCOTX7503301/08/202004/01/2020  04/01/2020
Contract DetailWALGREENS SPECIALTY PHARMACY, LLCDBA WALGREENS SPECIALTY PHARMACY #16287 130 ENTERPRISE DR
PITTSBURGHPA1527501/08/202004/01/2020  04/01/2020
Contract DetailWALMART PHARMACY 10-24437821 S. MINNESOTA AVENUE
SIOUX FALLSSD57108-727110/05/201601/01/2017  08/03/2017
Contract DetailWALMART PHARMACY 10-48655200 WEST 60TH STREET NORTH
SIOUX FALLSSD5710704/15/201507/01/2015  08/03/2017
Contract DetailWALMART PHARMACY 10-51692252 NORTH 8TH STREET
SUITE A 		ROGERSAR7275601/10/202304/01/2023  04/01/2023
Contract DetailWalmart Pharmacy 10-76112501 Perry Rd
PlainfieldIN4616810/12/202301/01/2024  01/01/2024
Contract DetailWULLSTEIN PHARMACY INCDBA BRANDON PHARMACY 116 E HOLLY BLVD
BRANDONSD5700504/11/201307/01/2013  08/03/2017
Parent/Child
340B IDHierarchyEntity TypeNameSub NameAddressCityState340B Status
DSH430016AChildDSHAVERA MCKENNANAvera Medical Group Internal Medicine1301 S CLIFF AVESIOUX FALLSSDActive
DSH430016AAChildDSHAVERA MCKENNANAvera Medical Group Family Medicine - Marion Rd2100 S Marion RdSioux FallsSDActive
DSH430016ABChildDSHAVERA MCKENNANAvera Medical Group McGreevy - West Benson Rd4011 W Benson RdSioux FallsSDActive
DSH430016ACChildDSHAVERA MCKENNANAvera Medical Group Tea725 E Figzel CourtTeaSDActive
DSH430016ADChildDSHAVERA MCKENNANAvera Medical Group Urogynecology6100 S Louise AveSioux FallsSDActive
DSH430016AEChildDSHAVERA MCKENNANAvera Brain & Spine Institute1301 S CLIFF AVESIOUX FALLSSDTerminated
DSH430016AFChildDSHAVERA MCKENNANAvera Medical Group Gastroenterology6100 S Louise AveSIOUX FALLSSDActive
DSH430016AGChildDSHAVERA MCKENNANAvera Transplant & Liver Surgery911 E 20th StSioux FallsSDActive
DSH430016AHChildDSHAVERA MCKENNANAvera Medical Group Obstetrics & Gynecology1417 S CLIFF AVESIOUX FALLSSDActive
DSH430016AJChildDSHAVERA MCKENNANAvera Medical Group Certified Nurse Midwifery1417 S CLIFF AVESioux FallsSDActive
DSH430016AKChildDSHAVERA MCKENNANAvera Medical Group Radiology - Diagnostic1000 E 23rd StreetSioux FallsSDActive
DSH430016ALChildDSHAVERA MCKENNANAvera Medical Group Radiology - CT Scan1301 S Cliff AveSioux FallsSDActive
DSH430016AMChildDSHAVERA MCKENNANAvera Medical Group Radiology - PET1000 E 23rd StSioux FallsSDActive
DSH430016ANChildDSHAVERA MCKENNANAvera Medical Group Internal Medicine Women's Clinic6215 South Cliff AveSioux FallsSDActive
DSH430016APChildDSHAVERA MCKENNANAvera Medical Group Obstetrics & Gynecology - Cliff Ave.6215 S Cliff AveSioux FallsSDActive
DSH430016AQChildDSHAVERA MCKENNANAvera Medical Group Obstetrics & Gynecology- Marion Rd.2100 S Marion RdSioux FallsSDActive
DSH430016ARChildDSHAVERA MCKENNANEmergency Department West2100 S Marion RdSioux FallsSDActive
DSH430016ASChildDSHAVERA MCKENNANAvera Orthopedics6100 S Louise AveSioux FallsSDActive
DSH430016ATChildDSHAVERA MCKENNANPain Clinic1301 S Cliff AveSioux FallsSDActive
DSH430016AUChildDSHAVERA MCKENNANAvera Medical Group Plastic & Reconstructive Surgery1417 S CLIFF AVESIOUX FALLSSDActive
DSH430016AVChildDSHAVERA MCKENNANAvera Digestive Disease Institute - Endoscopy/Colonoscopy6100 S Louise AveSioux FallsSDActive
DSH430016AWChildDSHAVERA MCKENNANAvera Medical Group Orthopedics & Sports Medicine911 E 20th StreetSioux FallsSDActive
DSH430016AXChildDSHAVERA MCKENNANMcKennan Outpatient Infusion1417 S Cliff AvenueSioux FallsSDActive
DSH430016AYChildDSHAVERA MCKENNANAvera Medical Group Internal Medicine - Louise Ave6100 S. Louise AveSioux FallsSDActive
DSH430016AZChildDSHAVERA MCKENNANAvera Medical Group Infectious Disease Specialists6709 S Minnesota AveSioux FallsSDActive
DSH430016BChildDSHAVERA MCKENNANAvera Medical Group Oncology & Hematology1000 E 23RD STSIOUX FALLSSDActive
DSH430016BAChildDSHAVERA MCKENNANAvera Medical Group - Maternal Fetal Medicine1417 S Cliff AveSioux FallsSDActive
DSH430016BBChildDSHAVERA MCKENNANAvera Medical Group - Pediatric Specialists1417 S Cliff AvenueSioux FallsSDActive
DSH430016BCChildDSHAVERA MCKENNANNeuro Endovascular1301 S Cliff AveSioux FallsSDActive
DSH430016BDChildDSHAVERA MCKENNANNeuro Critical Care1301 S Cliff AveSioux FallsSDActive
DSH430016BEChildDSHAVERA MCKENNANNeurosurgery1301 S Cliff AveSioux FallsSDActive
DSH430016BFChildDSHAVERA MCKENNANAvera Medical Group Neurology1301 S Cliff AveSioux FallsSDActive
DSH430016BGChildDSHAVERA MCKENNANAvera Medical Group Dermatology - Marion Rd2100 S Marion RdSioux FallsSDActive
DSH430016BHChildDSHAVERA MCKENNANAvera Medical Group - Breast Oncology1000 E 23rd StSioux FallsSDActive
DSH430016BJChildDSHAVERA MCKENNANAvera Medical Group - Dermatology - Dawley Farms1600 S Highline AveSioux FallsSDActive
DSH430016BKChildDSHAVERA MCKENNANAvera Medical Group - Internal Medicine - Dawley Farms1600 S Highline AveSioux FallsSDActive
DSH430016BLChildDSHAVERA MCKENNANAvera Medical Group - Family Practice - Dawley Farms1600 S Highline AveSioux FallsSDActive
DSH430016BMChildDSHAVERA MCKENNANAvera Medical Group Orthopedics - Hand Clinic6100 S Louise AveSioux FallsSDActive
DSH430016BNChildDSHAVERA MCKENNANAvera Medical Group Obstetrics - Dawley Farms1600 South Highline AveSioux FallsSDActive
DSH430016BPChildDSHAVERA MCKENNANAvera Medical Group Pediatrics Dawley Farms - Pediatrics1600 South Highline AveSioux FallsSDActive
DSH430016BQChildDSHAVERA MCKENNANAvera Medical Group - Maternal Fetal Medicine - Dawley Farm1600 Highline AveSioux FallsSDActive
DSH430016BRChildDSHAVERA MCKENNANAvera Medical Group - ENT1417 S Cliff AveSioux FallsSDActive
DSH430016BSChildDSHAVERA MCKENNANAvera Medical Group - Comprehensive Breast1000 E 23rdSioux FallsSDActive
DSH430016BTChildDSHAVERA MCKENNANAvera Medical Group - Radiation Oncology1000 E 23rdSioux FallsSDActive
DSH430016BUChildDSHAVERA MCKENNANAvera Comprehensive Weight Management6000 W 41st StSioux FallsSDActive
DSH430016BVChildDSHAVERA MCKENNANED East - Emergency Room1600 S Highline AveSioux FallsSDActive
DSH430016BWChildDSHAVERA MCKENNANAvera on Louise - Outpatient Surgery6100 S Louise AveSioux FallsSDActive
DSH430016BXChildDSHAVERA MCKENNANAvera Dialysis4210 West 53rd StSioux FallsSDActive
DSH430016BYChildDSHAVERA MCKENNANAvera Behavioral Health - Partial Hospital Program4400 W 69th StSioux FallsSDActive
DSH430016BZChildDSHAVERA MCKENNANAvera Dialysis - Brookings - Renal Therapy300 22nd AveBrookingsSDActive
DSH430016CChildDSHAVERA MCKENNANAvera Medical Group Hematology, Transplant & Cellular Therapy1000 E 23RD STSIOUX FALLSSDActive
DSH430016CAChildDSHAVERA MCKENNANAvera Dialysis - Milbank - Renal Therapy301 Flynn DrMilbankSDActive
DSH430016CBChildDSHAVERA MCKENNANAvera Dialysis - Mitchell - Renal Therapy1900 Grassland DriveMitchellSDActive
DSH430016CCChildDSHAVERA MCKENNANNew Hope Dialysis Center - Renal Therapy310 W SD Hwy 46WagnerSDActive
DSH430016DChildDSHAVERA MCKENNANAvera Medical Group Pulmonary & Sleep Medicine1301 S CLIFF AVESIOUX FALLSSDActive
DSH430016EChildDSHAVERA MCKENNANAvera Nephrology Plaza 2 & 4911 E 20th StSioux FallsSDActive
DSH430016FChildDSHAVERA MCKENNANAvera Endocrinology & Diabetes1600 S. Highline AveSioux FallsSDActive
DSH430016GChildDSHAVERA MCKENNANAvera Therapy1301 S CLIFF AVESIOUX FALLSSDActive
DSH430016HChildDSHAVERA MCKENNANAvera Medical Group Rheumatology6100 S Louise AveSioux FallsSDActive
DSH430016JChildDSHAVERA MCKENNANAvera Medical Group Behavioral Health - Children4400 W 69TH STREETSIOUX FALLSSDActive
DSH430016KChildDSHAVERA MCKENNANAvera Medical Group Behavioral Health - Adult4400 W 69TH STSIOUX FALLSSDActive
DSH430016LChildDSHAVERA MCKENNANAvera Medical Group Gynecologic Oncology1000 E 23RD STSioux FallsSDActive
DSH430016MChildDSHAVERA MCKENNANAvera Medical Group Eye Care911 East 20th St.Sioux FallsSDTerminated
DSH430016NChildDSHAVERA MCKENNANAvera Medical Group Dermatology6701 S Minnesota AveSioux FallsSDActive
DSH430016PChildDSHAVERA MCKENNANAvera Liver Disease1600 S. Highline AveSioux FallsSDActive
DSH430016RChildDSHAVERA MCKENNAN HOSPITAL AND UNIVERSITY HEALTH CENTERAvera Medical Group McHale Institute3720 W 69th Street # 1Sioux FallsSDTerminated
DSH430016SChildDSHAVERA MCKENNANAvera Medical Group McGreevy - 69th and Western1910 W 69th StSioux FallsSDActive
DSH430016TChildDSHAVERA MCKENNANAvera Medical Group McGreevy - 7th Ave1200 S 7th AveSioux FallsSDActive
DSH430016UChildDSHAVERA MCKENNANAvera Medical Group McGreevy - Brandon1101 E Holly BlvdBrandonSDActive
DSH430016VChildDSHAVERA MCKENNANAvera Medical Group McGreevy - Dawley Farm1035 S HIGHLINE PLACESIOUX FALLSSDTerminated
DSH430016WChildDSHAVERA MCKENNANAvera Medical Group Harrisburg220 S Cliff AveHarrisburgSDActive
DSH430016XChildDSHAVERA MCKENNANAvera Medical Group Pediatrics - Marion Rd.2100 S MARION RDSIOUX FALLSSDActive
DSH430016ZChildDSHAVERA MCKENNANAvera Medical Group Family Medicine - Cliff Ave.6215 S CLIFF AVESioux FallsSDActive
History
SectionFieldActionActivityValue BeforeValue AfterTimestamp 
AddressesShipping AddressUpdateChange RequestAvera Long-Term Care Pharmacy 3820 N Potsdam Ave Ste 2 Sioux Falls, SD 57104-0000Avera Long-Term Care Pharmacy 4101 W. Memory Cr. Ste 120 Sioux Falls, SD 57107-00004/25/2025 2:06 PM
AddressesShipping AddressUpdateChange RequestAvera Central Distribution 3820 N. Potsdam Ave. Suite #3 Sioux Falls, SD 57104Avera Central Distribution 4101 W Memory Circle, Ste 150 Sioux Falls, SD 571074/7/2025 11:22 AM
AddressesShipping AddressDeleteRecertificationAVERA MCKENNAN HOME INFUSION 1020 S CLIFF AVE SIOUX FALLS, SD 57104 9/5/2024 12:15 PM
AddressesShipping AddressInsertRecertification AVERA MCKENNAN HOME INFUSION PHARMACY 1020 S CLIFF AVE SIOUX FALLS, SD 571049/5/2024 12:15 PM
DetailsLast Recertification DateUpdateRecertification9/1/2023 12:04:25 PM9/5/2024 12:15:21 PM9/5/2024 12:15 PM
AddressesShipping AddressUpdateChange RequestAVERA SPECIALTY PHARMACY 500 E 56TH ST N STE 3150 SIOUX FALLS, SD 57105AVERA SPECIALTY PHARMACY 500 E 56TH ST N STE 3150 SIOUX FALLS, SD 571042/13/2024 2:17 PM
AddressesShipping AddressInsertChange Request Safecor 4060 Business Park Dr Ste B Columbus, OH 43204-50471/22/2024 7:32 AM
DetailsLast Recertification DateUpdateRecertification9/14/2022 10:44:56 AM9/1/2023 12:04:25 PM9/1/2023 12:04 PM
AddressesShipping AddressUpdateChange RequestAVERA SPECIALTY PHARMACY 1301 S Cliff Ave STE 200 SIOUX FALLS, SD 57105AVERA SPECIALTY PHARMACY 500 E 56TH ST N STE 3150 SIOUX FALLS, SD 571052/28/2023 12:21 PM
AddressesShipping AddressInsertChange Request Avera Plaza 2 Pharmacy 1301 S Cliff Ave Ste 225 Sioux Falls, SD 5710510/7/2022 8:28 AM
DetailsLast Recertification DateUpdateRecertification9/2/2021 11:21:12 AM9/14/2022 10:44:56 AM9/14/2022 10:44 AM
AddressesShipping AddressDeleteRecertificationAvera Queen of Peace Hospital 525 N. Foster St Attn Pharmacy Mitchell, SD 57301 9/2/2021 11:21 AM
AddressesShipping AddressDeleteRecertificationAvera St Luke's 305 South State Street Attn: Pharmacy Aberdeen, SD 57401 9/2/2021 11:21 AM
AddressesShipping AddressDeleteRecertificationAvera St Mary's Hospital 801 E Sioux Ave Pierre, SD 57501 9/2/2021 11:21 AM
AddressesMain AddressUpdateRecertification 1325 SOUTH CLIFF AVENUE SIOUX FALLS, SD 57105 1325 S. CLIFF AVE. SIOUX FALLS, SD 571059/2/2021 11:21 AM
DetailsLast Recertification DateUpdateRecertification8/31/2020 1:17:49 PM9/2/2021 11:21:12 AM9/2/2021 11:21 AM
AddressesShipping AddressDeleteChange RequestAvera on Louise Inpatient Pharmacy 6100 S. Louise Ave. Sioux Falls, SD 57108 6/7/2021 3:06 PM
AddressesShipping AddressInsertChange Request Avera on Louise Inpatient Pharmacy 6100 S. Louise Ave. STE B300 Sioux Falls, SD 571086/7/2021 3:06 PM
ContactsAuthorizing OfficialUpdateChange RequestPetersen, Steve Vice President of Pharmacy Avera 6053228313Goff, Melissa Vice President - Pharmacy Avera 60532285485/24/2021 7:02 PM
ContactsPrimary ContactUpdateProfile Change RequestFriesen, Brandy 340b Coordinator Avera 6053228446Friesen, Brandy Pharmacy Regulatory Analyst Avera 60532284464/28/2021 1:48 PM
AddressesShipping AddressInsertChange Request Avera Central Distribution 3820 N. Potsdam Ave. Suite #3 Sioux Falls, SD 571041/22/2021 8:18 AM
DetailsLast Recertification DateUpdateRecertification9/4/2019 11:26:09 AM8/31/2020 1:17:49 PM8/31/2020 1:17 PM
AddressesShipping AddressDeleteChange RequestAvera Long-Term Care Pharmacy 3620 N Potsdam Ave Ste 2 Sioux Falls, SD 57104-0000 8/14/2020 1:22 PM
AddressesShipping AddressInsertChange Request Avera Long-Term Care Pharmacy 3820 N Potsdam Ave Ste 2 Sioux Falls, SD 57104-00008/14/2020 1:22 PM
AddressesShipping AddressInsertChange Request Avera Long-Term Care Pharmacy 3620 N Potsdam Ave Ste 2 Sioux Falls, SD 57104-00008/6/2020 10:19 AM
AddressesShipping AddressDeleteChange RequestAvera Medical Group Internal Medicine 6100 S Louise Ave Suite 1120 Sioux Falls, SD 57108 4/7/2020 10:47 AM
AddressesShipping AddressInsertChange Request Avera St Luke's 305 South State Street Attn: Pharmacy Aberdeen, SD 574013/25/2020 3:29 PM
AddressesShipping AddressInsertChange Request Avera St Mary's Hospital 801 E Sioux Ave Pierre, SD 575013/25/2020 3:29 PM
AddressesShipping AddressInsertChange Request Avera Queen of Peace Hospital 525 N. Foster St Attn Pharmacy Mitchell, SD 573013/25/2020 3:29 PM
AddressesShipping AddressInsertChange Request Avera Medical Group Internal Medicine 6100 S Louise Ave Suite 1120 Sioux Falls, SD 5710811/5/2019 7:08 AM
AddressesShipping AddressInsertChange Request Avera on Louise Inpatient Pharmacy 6100 S. Louise Ave. Sioux Falls, SD 571089/30/2019 11:08 AM
DetailsLast Recertification DateUpdateRecertification9/5/2018 12:00:03 PM9/4/2019 11:26:09 AM9/4/2019 11:26 AM
AddressesShipping AddressInsertChange Request Avera on Louise Pharmacy 6100 S Louise Ave Suite 1100 Sioux Falls, SD 571084/29/2019 8:46 AM
AddressesShipping AddressInsertChange Request Avera McKennan Hospital 1325 S Cliff Avenue Sioux Falls, SD 5710511/19/2018 4:14 PM
AddressesMain AddressUpdateChange Request 1325 SOUTH CLIFF AVE SIOUX FALLS, SD 57105 1325 SOUTH CLIFF AVENUE SIOUX FALLS, SD 571059/12/2018 4:40 PM
AddressesShipping AddressDeleteChange RequestAVERA DISTRIBUTION CENTER 3301 N 1ST AVE. SIOUX FALLS, SD 57104 9/12/2018 4:40 PM
AddressesShipping AddressDeleteChange RequestAvera 7th Avenue Pharmacy 1200 S. 7th Ave Suite 101 Sioux Falls, SD 57105 9/12/2018 4:40 PM
AddressesShipping AddressDeleteChange RequestAVERA 69TH STREET PHARMACY 4400 W 69TH STREET SIOUX FALLS, SD 57108 9/12/2018 4:40 PM
AddressesShipping AddressDeleteChange RequestAVERA CAMPUS PHARMACY 1325 S CLIFF AVE STE CP SIOUX FALLS, SD 57105-1008 9/12/2018 4:40 PM
AddressesShipping AddressDeleteChange RequestAVERA HOME INFUSION PHARMACY 1020 S CLIFF AVE SIOUX FALLS, SD 57104 9/12/2018 4:40 PM
AddressesShipping AddressInsertChange Request AVERA DISTRIBUTION CENTER 3301 N 1ST AVE SIOUX FALLS, SD 571049/12/2018 4:40 PM
AddressesShipping AddressInsertChange Request Avera 7th Avenue Pharmacy 1200 S. 7TH AVENUE SUITE 101 Sioux Falls, SD 571059/12/2018 4:40 PM
AddressesShipping AddressInsertChange Request AVERA 69TH STREET PHARMACY 4400 W 69TH STREET SUITE 300 SIOUX FALLS, SD 57108-00009/12/2018 4:40 PM
AddressesShipping AddressInsertChange Request AVERA MCKENNAN CAMPUS PHARMACY 1325 S CLIFF AVE STE CP SIOUX FALLS, SD 57105-10089/12/2018 4:40 PM
AddressesShipping AddressInsertChange Request AVERA MCKENNAN HOME INFUSION 1020 S CLIFF AVE SIOUX FALLS, SD 571049/12/2018 4:40 PM
AddressesMain AddressUpdateRecertification 1325 SOUTH CLIFF AVENUE SIOUX FALLS, SD 57105 1325 SOUTH CLIFF AVE SIOUX FALLS, SD 571059/5/2018 12:00 PM
AddressesShipping AddressInsertRecertification AVERA DERMATOLOGY PHARMACY 6701 S. MINNESOTA AVE SIOUX FALLS, SD 571089/5/2018 12:00 PM
AddressesShipping AddressInsertRecertification AVERA 69TH STREET PHARMACY 4400 W 69TH STREET SIOUX FALLS, SD 571089/5/2018 12:00 PM
AddressesShipping AddressInsertRecertification AVERA CAMPUS PHARMACY 1325 S CLIFF AVE STE CP SIOUX FALLS, SD 57105-10089/5/2018 12:00 PM
AddressesShipping AddressInsertRecertification AVERA HOME INFUSION PHARMACY 1020 S CLIFF AVE SIOUX FALLS, SD 571049/5/2018 12:00 PM
AddressesShipping AddressInsertRecertification AVERA SPECIALTY PHARMACY 1301 S Cliff Ave STE 200 SIOUX FALLS, SD 571059/5/2018 12:00 PM
DetailsLast Recertification DateUpdateRecertification11/8/2017 2:01:22 PM9/5/2018 12:00:03 PM9/5/2018 12:00 PM
DetailsEntity NameUpdateRecertificationAVERA MCKENNAN HOSPITAL AND UNIVERSITY HEALTH CENTERAVERA MCKENNAN9/5/2018 12:00 PM
AddressesShipping AddressDeleteChange RequestAvera 7th Ave Pharmacy 1200 7th Ave Ste. 101 Sioux Falls, SD 57105 1/8/2018 3:12 PM
AddressesShipping AddressInsertChange Request Avera 7th Avenue Pharmacy 1200 S. 7th Ave Suite 101 Sioux Falls, SD 571051/8/2018 3:12 PM
AddressesShipping AddressInsertChange Request Avera 7th Ave Pharmacy 1200 7th Ave Ste. 101 Sioux Falls, SD 5710512/27/2017 2:32 PM
ContactsAuthorizing OfficialUpdateChange RequestFlicek, David Avera McKennan President/CEO Avera McKennan 6053227916Petersen, Steve Vice President of Pharmacy Avera 605322831312/27/2017 2:32 PM
ContactsPrimary ContactInsertRecertification Friesen, Brandy 340b Coordinator Avera 605322844611/8/2017 2:01 PM
DetailsLast Recertification DateUpdateRecertification8/25/2016 12:00:00 AM11/8/2017 2:01:22 PM11/8/2017 2:01 PM
ContactsAuthorizing OfficialUpdate Flicek, David Avera McKennan President/CEO 6053227916Flicek, David Avera McKennan President/CEO Avera McKennan 605322791610/12/2017 5:09 PM
ContactsAuthorizing OfficialInsert  Flicek, David Avera McKennan President/CEO 60532279168/3/2017 11:37 AM
AddressesMain AddressInsert   1325 SOUTH CLIFF AVENUE SIOUX FALLS, SD 571058/3/2017 11:37 AM
AddressesBilling AddressInsert  Avera McKennan Hospital PO BOX 5045 Sioux Falls, SD 571178/3/2017 11:37 AM
AddressesShipping AddressInsert  AVERA DISTRIBUTION CENTER 3301 N 1ST AVE. SIOUX FALLS, SD 571048/3/2017 11:37 AM
DetailsLast Recertification DateUpdate 8/26/2015 12:00:00 AM8/25/2016 12:00:00 AM8/25/2016 12:33 PM
DetailsLast Recertification DateUpdate 8/12/2014 12:00:00 AM8/26/2015 12:00:00 AM8/26/2015 1:40 PM
DetailsLast Recertification DateUpdate 9/5/2013 12:00:00 AM8/12/2014 12:00:00 AM8/12/2014 11:25 AM
DetailsLast Recertification DateUpdate 7/1/2012 12:00:00 AM9/5/2013 12:00:00 AM9/5/2013 5:35 PM
DetailsLast Recertification DateUpdate  7/1/2012 12:00:00 AM5/14/2012 9:01 AM
DetailsComments PublicInsert  8/17/11 ADDED NPI #; 7/8/11 UPDATED ZIP (WAS 57117); 8/31/09 - DOC RECD TO CONFIRM ELIG DSH ADJ %;05/05/11 UPDATED ADDR.(WAS 800 EAST 21ST STREET)8/17/2011 1:13 PM
DetailsLast Recertification DateInsert   7/8/2011 11:32 AM
DetailsGrant NumberInsert   7/8/2011 11:32 AM
Details340B IDInsert  DSH4300167/8/2011 11:32 AM
DetailsIs Authorizing Official EHB DataInsert   7/8/2011 11:32 AM
DatesLast Date That 340B Drugs PurchasedInsert   7/8/2011 11:32 AM
DetailsMedicare Provider NumberInsert  4300167/8/2011 11:32 AM
DetailsEntity NameInsert  AVERA MCKENNAN HOSPITAL AND UNIVERSITY HEALTH CENTER7/8/2011 11:32 AM
DetailsProgram CodeInsert  DSH7/8/2011 11:32 AM
DetailsEntity SubnameInsert   7/8/2011 11:32 AM
DatesParticipating Approval DateInsert  9/18/2008 12:00:00 AM7/8/2011 11:32 AM
DetailsStateInsert  Active7/8/2011 11:32 AM
DatesRegistration DateInsert  9/17/2008 12:00:00 AM7/8/2011 11:32 AM
DatesSigned By DateInsert  8/28/2008 12:00:00 AM7/8/2011 11:32 AM
DatesStart DateInsert  9/18/2008 12:00:00 AM7/8/2011 11:32 AM
TerminationsTermination CommentsInsert   7/8/2011 11:32 AM
TerminationsTermination DateInsert   7/8/2011 11:32 AM
TerminationsTermination Effective DateInsert   7/8/2011 11:32 AM
TerminationsTermination ReasonInsert   7/8/2011 11:32 AM
DetailsComments PublicInsert  7/8/11 UPDATED ZIP (WAS 57117); 8/31/09 - DOC RECD TO CONFIRM ELIG DSH ADJ %;05/05/11 UPDATED ADDR.(WAS 800 EAST 21ST STREET)7/8/2011 11:32 AM