| 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 | 8/21/2023 8:19:38 AM | 8/28/2024 11:27:11 AM | 8/28/2024 11:27 AM |
| Addresses | Shipping Address | Insert | Change Request | | Avera Holy Family Health
826 N 8th St
Estherville, IA 51334 | 10/12/2023 12:50 PM |
| Addresses | Shipping Address | Insert | Change Request | | Avera Pharmacy Distribution Center
3820 N Potsdam Ave
Ste 3
Sioux Falls, SD 57104 | 10/12/2023 12:50 PM |
| Details | Last Recertification Date | Update | Recertification | 9/19/2022 7:14:36 AM | 8/21/2023 8:19:38 AM | 8/21/2023 8:19 AM |
| Details | Last Recertification Date | Update | Recertification | 9/1/2021 10:10:55 AM | 9/19/2022 7:14:36 AM | 9/19/2022 7:14 AM |
| Addresses | Main Address | Update | Recertification |
826 N 8TH STREET
ESTHERVILLE, IA 51334 |
826 N 8TH ST
ESTHERVILLE, IA 51334 | 9/1/2021 10:10 AM |
| Details | Last Recertification Date | Update | Recertification | 9/1/2020 8:20:48 AM | 9/1/2021 10:10:55 AM | 9/1/2021 10:10 AM |
| Contacts | Authorizing Official | Update | Change Request | Petersen, Steve
Vice President of Pharmacy
Avera
6053228313 | Goff, Melissa
Vice President - Pharmacy
Avera
6053228548 | 5/4/2021 12:55 PM |
| 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 | 8/22/2019 1:01:09 PM | 9/1/2020 8:20:48 AM | 9/1/2020 8:20 AM |
| Details | Last Recertification Date | Update | Recertification | 8/28/2018 11:05:37 AM | 8/22/2019 1:01:09 PM | 8/22/2019 1:01 PM |
| Details | Entity Name | Update | Recertification | Avera Holy Family | Avera Holy Family Health | 8/22/2019 1:01 PM |
| Contacts | Authorizing Official | Update | Change Request | Adams, Shannon
CFO
Avera Holy Family
7123622631 | Petersen, Steve
Vice President of Pharmacy
Avera
6053228313 | 7/30/2019 3:38 PM |
| Details | Entity Name | Update | Change Request | Avera Holy Family Health | Avera Holy Family | 11/21/2018 10:59 AM |
| Addresses | Main Address | Update | Recertification |
826 N. 8TH STREET.
ESTHERVILLE, IA 51334 |
826 N 8TH STREET
ESTHERVILLE, IA 51334 | 8/28/2018 11:05 AM |
| Details | Last Recertification Date | Update | Recertification | 11/16/2017 5:50:39 PM | 8/28/2018 11:05:37 AM | 8/28/2018 11:05 AM |
| Details | Entity Name | Update | Recertification | Avera Holy Family Hospital | Avera Holy Family Health | 8/28/2018 11:05 AM |
| Contacts | Primary Contact | Update | Recertification | Hough, Kristi
PHARMACY MANAGER
7123626176 | Friesen, Brandy
340b Coordinator
Avera
6053228446 | 11/16/2017 5:50 PM |
| Details | Last Recertification Date | Update | Recertification | 8/19/2016 12:00:00 AM | 11/16/2017 5:50:39 PM | 11/16/2017 5:50 PM |
| Contacts | Authorizing Official | Update | | Adams, Shannon
CFO
7123622631 | Adams, Shannon
CFO
Avera Holy Family
7123622631 | 10/25/2017 12:40 PM |
| Addresses | Main Address | Insert | | |
826 N. 8TH STREET.
ESTHERVILLE, IA 51334 | 8/30/2016 9:17 AM |
| Contacts | Primary Contact | Insert | | | Hough, Kristi
PHARMACY MANAGER
7123626176 | 8/30/2016 9:17 AM |
| Contacts | Authorizing Official | Update | | HALL, MICHAEL
CEO
7123622631-6160 | Adams, Shannon
CFO
7123622631 | 8/30/2016 9:17 AM |
| Details | Last Recertification Date | Update | | 8/18/2015 12:00:00 AM | 8/19/2016 12:00:00 AM | 8/30/2016 9:17 AM |
| Details | Last Recertification Date | Update | | 8/21/2014 12:00:00 AM | 8/18/2015 12:00:00 AM | 8/18/2015 10:07 AM |
| Details | Last Recertification Date | Update | | 8/23/2013 11:21:18 AM | 8/21/2014 12:00:00 AM | 8/21/2014 10:14 AM |
| Contacts | Authorizing Official | Insert | | | HALL, MICHAEL
CEO
7123622631-6160 | 8/23/2013 11:21 AM |
| Details | Last Recertification Date | Update | | 7/1/2012 12:00:00 AM | 8/23/2013 11:21:18 AM | 8/23/2013 11:21 AM |
| Details | Last Recertification Date | Update | | | 7/1/2012 12:00:00 AM | 5/31/2012 8:17 AM |
| Details | Comments Public | Insert | | | 7/25/11 updated name(was AVERA HOLY FAMILY HEALTH) 10/22/2010- UPDATED ADD (WAS 826 N. 8 ST.)
9/21/11-added NPI # | 9/21/2011 9:57 AM |
| Details | Entity Name | Update | | AVERA HOLY FAMILY HEALTH | Avera Holy Family Hospital | 7/25/2011 12:12 PM |
| Details | Comments Public | Insert | | | 7/25/11 updated name(was AVERA HOLY FAMILY HEALTH) 10/22/2010- UPDATED ADD (WAS 826 N. 8 ST.) | 7/25/2011 12:12 PM |
| Details | Last Recertification Date | Insert | | | | 12/7/2010 3:02 PM |
| Details | Grant Number | Insert | | | | 12/7/2010 3:02 PM |
| Details | 340B ID | Insert | | | CAH161351-00 | 12/7/2010 3:02 PM |
| Details | Is Authorizing Official EHB Data | Insert | | | | 12/7/2010 3:02 PM |
| Dates | Last Date That 340B Drugs Purchased | Insert | | | | 12/7/2010 3:02 PM |
| Details | Medicare Provider Number | Insert | | | 161351 | 12/7/2010 3:02 PM |
| Details | Entity Name | Insert | | | AVERA HOLY FAMILY HEALTH | 12/7/2010 3:02 PM |
| Details | Program Code | Insert | | | CAH | 12/7/2010 3:02 PM |
| Details | Entity Subname | Insert | | | | 12/7/2010 3:02 PM |
| Dates | Participating Approval Date | Insert | | | 9/30/2010 12:00:00 AM | 12/7/2010 3:02 PM |
| Details | State | Insert | | | Active | 12/7/2010 3:02 PM |
| Dates | Registration Date | Insert | | | 9/30/2010 12:00:00 AM | 12/7/2010 3:02 PM |
| Dates | Signed By Date | Insert | | | 9/27/2010 12:00:00 AM | 12/7/2010 3:02 PM |
| Dates | Start Date | Insert | | | 9/30/2010 12:00:00 AM | 12/7/2010 3:02 PM |
| Terminations | Termination Comments | Insert | | | | 12/7/2010 3:02 PM |
| Terminations | Termination Date | Insert | | | | 12/7/2010 3:02 PM |
| Terminations | Termination Effective Date | Insert | | | | 12/7/2010 3:02 PM |
| Terminations | Termination Reason | Insert | | | | 12/7/2010 3:02 PM |
| Details | Comments Public | Insert | | | 10/22/2010- UPDATED ADD (WAS 826 N. 8 ST.) | 12/7/2010 3:02 PM |