| Addresses | Shipping Address | Update | Change Request | Avera Pharmacy Distribution Center
3820 N Potsdam Ave
Ste 3
Sioux Falls, SD 57104 | Avera Pharmacy Distribution Center
4101 W Memory Circle, Ste 150
Sioux Falls, SD 57107 | 4/8/2025 9:00 AM |
| Details | Last Recertification Date | Update | Recertification | 8/16/2023 1:42:15 PM | 8/16/2024 4:08:35 PM | 8/16/2024 4:08 PM |
| Addresses | Shipping Address | Insert | Change Request | | Sioux Center Health
1101 9th St SE
Sioux Center, IA 51250 | 10/10/2023 2:41 PM |
| Addresses | Shipping Address | Insert | Change Request | | Avera Pharmacy Distribution Center
3820 N Potsdam Ave
Ste 3
Sioux Falls, SD 57104 | 10/10/2023 2:41 PM |
| Details | Last Recertification Date | Update | Recertification | 9/19/2022 7:13:59 AM | 8/16/2023 1:42:15 PM | 8/16/2023 1:42 PM |
| Details | Last Recertification Date | Update | Recertification | 8/19/2021 11:19:02 AM | 9/19/2022 7:13:59 AM | 9/19/2022 7:13 AM |
| Details | Last Recertification Date | Update | Recertification | 9/1/2020 8:32:36 AM | 8/19/2021 11:19:02 AM | 8/19/2021 11:19 AM |
| Contacts | Primary Contact | Update | Profile Change Request | Friesen, Brandy
340b Coordinator
Avera
6053228446 | Friesen, Brandy
Pharmacy Regulatory Analyst
Avera
6053228446 | 4/28/2021 1:48 PM |
| Details | Last Recertification Date | Update | Recertification | 9/4/2019 2:08:36 PM | 9/1/2020 8:32:36 AM | 9/1/2020 8:32 AM |
| Details | Last Recertification Date | Update | Recertification | 8/30/2018 12:46:15 PM | 9/4/2019 2:08:36 PM | 9/4/2019 2:08 PM |
| Contacts | Authorizing Official | Update | Change Request | Sedelmeier, Monica
Interim CEO
Sioux Center Health
7127228415 | Nelson, Cory
CEO
Sioux Center Health
7127228107 | 10/22/2018 9:16 AM |
| Contacts | Authorizing Official | Update | Change Request | Schuiteman, Jackson
CFO
Sioux Center Health
7127228158 | Sedelmeier, Monica
Interim CEO
Sioux Center Health
7127228415 | 8/31/2018 7:50 AM |
| Addresses | Main Address | Update | Recertification |
1101 9th Street SE
SIOUX CENTER, IA 51250-1398 |
1101 9th St SE
SIOUX CENTER, IA 51250-1398 | 8/30/2018 12:46 PM |
| Details | Last Recertification Date | Update | Recertification | 11/20/2017 2:28:56 PM | 8/30/2018 12:46:15 PM | 8/30/2018 12:46 PM |
| Contacts | Authorizing Official | Update | Change Request | LEE, KAYLEEN
CHIEF EXECUTIVE OFFICER
Sioux Center Health
7127221271 | Schuiteman, Jackson
CFO
Sioux Center Health
7127228158 | 7/30/2018 11:28 AM |
| Contacts | Primary Contact | Insert | Recertification | | Friesen, Brandy
340b Coordinator
Avera
6053228446 | 11/20/2017 2:28 PM |
| Details | Last Recertification Date | Update | Recertification | 8/23/2016 12:00:00 AM | 11/20/2017 2:28:56 PM | 11/20/2017 2:28 PM |
| Contacts | Authorizing Official | Update | | LEE, KAYLEEN
CHIEF EXECUTIVE OFFICER
7127221271 | LEE, KAYLEEN
CHIEF EXECUTIVE OFFICER
Sioux Center Health
7127221271 | 11/20/2017 12:37 PM |
| Contacts | Authorizing Official | Insert | | | LEE, KAYLEEN
CHIEF EXECUTIVE OFFICER
7127221271 | 1/4/2017 3:54 PM |
| Addresses | Main Address | Insert | | |
1101 9th Street SE
SIOUX CENTER, IA 51250-1398 | 8/23/2016 9:08 AM |
| Details | Last Recertification Date | Update | | 8/5/2015 12:00:00 AM | 8/23/2016 12:00:00 AM | 8/23/2016 9:08 AM |
| Details | Last Recertification Date | Update | | 8/21/2014 12:00:00 AM | 8/5/2015 12:00:00 AM | 8/5/2015 11:46 AM |
| Details | Last Recertification Date | Update | | 8/26/2013 12:00:00 AM | 8/21/2014 12:00:00 AM | 8/21/2014 8:28 AM |
| Details | Last Recertification Date | Update | | 8/26/2013 8:15:15 AM | 8/26/2013 12:00:00 AM | 5/21/2014 1:00 PM |
| Details | Entity Name | Update | | SIOUX CENTER COMMUNITY HOSPITAL AND HEALTH CENTER AVERA | SIOUX CENTER HEALTH | 5/21/2014 1:00 PM |
| Details | Last Recertification Date | Update | | 7/1/2012 12:00:00 AM | 8/26/2013 8:15:15 AM | 8/26/2013 8:15 AM |
| Details | Last Recertification Date | Update | | | 7/1/2012 12:00:00 AM | 5/31/2012 8:17 AM |
| Details | Last Recertification Date | Insert | | | | 10/22/2010 3:41 PM |
| Details | Grant Number | Insert | | | | 10/22/2010 3:41 PM |
| Details | 340B ID | Insert | | | CAH161346-00 | 10/22/2010 3:41 PM |
| Details | Is Authorizing Official EHB Data | Insert | | | | 10/22/2010 3:41 PM |
| Dates | Last Date That 340B Drugs Purchased | Insert | | | | 10/22/2010 3:41 PM |
| Details | Medicare Provider Number | Insert | | | 161346 | 10/22/2010 3:41 PM |
| Details | Entity Name | Insert | | | SIOUX CENTER COMMUNITY HOSPITAL AND HEALTH CENTER AVERA | 10/22/2010 3:41 PM |
| Details | Program Code | Insert | | | CAH | 10/22/2010 3:41 PM |
| Details | Entity Subname | Insert | | | | 10/22/2010 3:41 PM |
| Dates | Participating Approval Date | Insert | | | 9/24/2010 12:00:00 AM | 10/22/2010 3:41 PM |
| Details | State | Insert | | | Active | 10/22/2010 3:41 PM |
| Dates | Registration Date | Insert | | | 9/23/2010 12:00:00 AM | 10/22/2010 3:41 PM |
| Dates | Signed By Date | Insert | | | 9/23/2010 12:00:00 AM | 10/22/2010 3:41 PM |
| Dates | Start Date | Insert | | | 9/28/2010 12:00:00 AM | 10/22/2010 3:41 PM |
| Terminations | Termination Comments | Insert | | | | 10/22/2010 3:41 PM |
| Terminations | Termination Date | Insert | | | | 10/22/2010 3:41 PM |
| Terminations | Termination Effective Date | Insert | | | | 10/22/2010 3:41 PM |
| Terminations | Termination Reason | Insert | | | | 10/22/2010 3:41 PM |
| Details | Comments Public | Insert | | | 10/22/2010- ADDED ZIP 2 | 10/22/2010 3:41 PM |