Covered Entity Details

CAH431338-00 Avera McKennan dba Avera Gregory Hospital (Active) - information as of 6/6/2025 12:34:07 PM

Main Details

Name

Avera McKennan dba Avera Gregory Hospital

Subdivision Name

Type

Critical Access Hospital

Rural

340B ID

CAH431338-00

Medicare Provider Number

431338

Additional Details

Current Program Status

Active

Registration Date

5/5/2011

Participating Start Date

10/1/2011

Participating Approval Date

9/1/2011

Last Recertification Date

8/28/2024

Contacts

Authorizing Official

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

Primary Contact

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

Addresses

Street Address

110 S. Logan Ave
Gregory, SD 57533

Billing Address

AVERA GREGORY HOSPITAL
P.O.BOX 408
GREGORY, SD 57533

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History

Comments

Comment	Last Updated On
02/10/2012 added NPI#	02/10/2012

Medicaid Billing

At this site, will the covered entity bill Medicaid fee-for-service for drugs purchased at 340B prices?
No

Shipping Addresses

Shipping Address 1

Avera Specialty Pharmacy
500 E 56th St N
Ste 3150
Sioux Falls, SD 57104-0408

Shipping Address 2

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

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Termination Date	Last Updated On
Contract Detail	GREGORY DRUG	604 MAIN ST		GREGORY	SD	57533	12/30/2011	12/30/2011		03/28/2013
Contract Detail	OPTUM INFUSION SERVICES 305, LLC	15529 COLLEGE BLVD.		LENEXA	KS	66219-1351	04/14/2025	07/01/2025		04/14/2025
Contract Detail	OPTUM PHARMACY 701, LLC	1830 S HORNE		MESA	AZ	85204	04/14/2025	07/01/2025		04/14/2025
Contract Detail	OPTUM PHARMACY 702, LLC	1050 PATROL RD		JEFFERSONVILLE	IN	47130	04/14/2025	07/01/2025		04/14/2025
Contract Detail	OPTUMRX	OPTUMRX INC	6800 W 115TH ST STE 600	OVERLAND PARK	KS	66211-9838	04/14/2025	07/01/2025		04/14/2025
Contract Detail	SHOPKO PHARMACY #2745	1140 E 5TH ST		WINNER	SD	57580	07/09/2015	10/01/2015	01/18/2019	04/12/2019
Contract Detail	THE WINNER PHARMACY, INC.	620 W 2ND ST		WINNER	SD	57580-1218	12/30/2011	12/30/2011		03/28/2013

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
CAH431338-01	Child	CAH	Avera McKennan dba Avera Gregory Hospital	AVERA MEDICAL GROUP-GREGORY	405 WHITTECAR	GREGORY	SD	Terminated
CAH431338-02	Child	CAH	Avera McKennan dba Avera Gregory Hospital	Avera Winner Medical Clinic	660 W 2ND ST	WINNER	SD	Active
CAH431338-03	Child	CAH	AVERA GREGORY HEALTHCARE CENTER	AVERA MEDICAL GROUP - COLOME	308 MAIN ST.	COLOME	SD	Terminated
CAH431338-04	Child	CAH	Avera McKennan dba Avera Gregory Hospital	AVERA MEDICAL GROUP - FAIRFAX	421 MAIN STREET	FAIRFAX	SD	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Addresses	Shipping Address	Update	Change Request	Avera Pharmacy Distribution Center 3820 N Potsdam Ave Ste3 Sioux Falls, SD 57104	Avera Pharmacy Distribution Center 4101 W Memory Circle, Ste 150 Sioux Falls, SD 57107	4/8/2025 12:00 PM
Details	Last Recertification Date	Update	Recertification	9/1/2023 7:35:51 AM	8/28/2024 11:24:27 AM	8/28/2024 11:24 AM
Addresses	Shipping Address	Insert	Change Request		Avera Pharmacy Distribution Center 3820 N Potsdam Ave Ste3 Sioux Falls, SD 57104	10/10/2023 1:36 PM
Details	Last Recertification Date	Update	Recertification	9/19/2022 9:20:10 AM	9/1/2023 7:35:51 AM	9/1/2023 7:35 AM
Addresses	Shipping Address	Update	Change Request	Avera Specialty Pharmacy 1301 S Cliff Ave Ste 200 Sioux Falls, SD 57105	Avera Specialty Pharmacy 500 E 56th St N Ste 3150 Sioux Falls, SD 57104-0408	3/13/2023 10:33 AM
Addresses	Main Address	Update	Change Request	400 PARK STREET GREGORY, SD 57533	110 S. Logan Ave Gregory, SD 57533	1/23/2023 7:27 AM
Addresses	Shipping Address	Insert	Change Request		Avera Specialty Pharmacy 1301 S Cliff Ave Ste 200 Sioux Falls, SD 57105	12/2/2022 11:44 AM
Details	Last Recertification Date	Update	Recertification	9/7/2021 9:58:20 AM	9/19/2022 9:20:10 AM	9/19/2022 9:20 AM
Details	Last Recertification Date	Update	Recertification	9/1/2020 8:46:14 AM	9/7/2021 9:58:20 AM	9/7/2021 9:58 AM
Details	Entity Name	Update	Recertification	AVERA GREGORY HEALTHCARE CENTER	Avera McKennan dba Avera Gregory Hospital	9/7/2021 9:58 AM
Contacts	Authorizing Official	Update	Change Request	Petersen, Steve Vice President of Pharmacy Avera 6053228313	Goff, Melissa Vice President - Pharmacy Avera 6053228548	5/3/2021 1:43 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	8/27/2019 2:07:01 PM	9/1/2020 8:46:14 AM	9/1/2020 8:46 AM
Details	Last Recertification Date	Update	Recertification	9/5/2018 11:51:31 AM	8/27/2019 2:07:01 PM	8/27/2019 2:07 PM
Details	Entity Name	Update	Recertification	AVERA GREGORY HOSPITAL	AVERA GREGORY HEALTHCARE CENTER	8/27/2019 2:07 PM
Details	Entity Name	Update	Change Request	AVERA GREGORY HEALTHCARE CENTER	AVERA GREGORY HOSPITAL	11/20/2018 2:06 PM
Addresses	Main Address	Update	Recertification	400 PARK AVENUE GREGORY, SD 57533	400 PARK STREET GREGORY, SD 57533	9/5/2018 11:51 AM
Details	Last Recertification Date	Update	Recertification	11/20/2017 3:44:14 PM	9/5/2018 11:51:31 AM	9/5/2018 11:51 AM
Details	Entity Name	Update	Recertification	AVERA GREGORY HOSPITAL	AVERA GREGORY HEALTHCARE CENTER	9/5/2018 11:51 AM
Contacts	Authorizing Official	Update	Change Request	BREITLING, BRYAN ADMINISTRATOR Avera Hand County Memorial Hospital 6058532421-399	Petersen, Steve Vice President of Pharmacy Avera 6053228313	12/27/2017 2:31 PM
Contacts	Primary Contact	Update	Recertification	Timanus, Anthony CEO/Administrator 6058355108	Friesen, Brandy 340b Coordinator Avera 6053228446	11/20/2017 3:44 PM
Details	Last Recertification Date	Update	Recertification	8/10/2016 12:00:00 AM	11/20/2017 3:44:14 PM	11/20/2017 3:44 PM
Contacts	Authorizing Official	Update	AO Change Request	Timanus, Anthony CEO/Administrator 6058355108	BREITLING, BRYAN ADMINISTRATOR Avera Hand County Memorial Hospital 6058532421-399	11/14/2017 7:22 AM
Addresses	Main Address	Insert			400 PARK AVENUE GREGORY, SD 57533	8/10/2016 9:19 AM
Contacts	Authorizing Official	Insert			Timanus, Anthony CEO/Administrator 6058355108	8/10/2016 9:19 AM
Contacts	Primary Contact	Insert			Timanus, Anthony CEO/Administrator 6058355108	8/10/2016 9:19 AM
Contacts	Primary Contact	Update		Friesen, Brandy Pharmacy Regulatory Analyst Avera 6053228446	Keiser, Trish CFO 6058355105	8/10/2016 9:19 AM
Details	Last Recertification Date	Update		8/10/2015 12:00:00 AM	8/10/2016 12:00:00 AM	8/10/2016 9:19 AM
Details	Last Recertification Date	Update		8/6/2014 12:00:00 AM	8/10/2015 12:00:00 AM	8/10/2015 12:42 PM
Details	Last Recertification Date	Update		8/19/2013 2:05:54 PM	8/6/2014 12:00:00 AM	8/6/2014 11:55 AM
Details	Last Recertification Date	Update			8/19/2013 2:05:54 PM	8/19/2013 2:05 PM
Addresses	Billing Address	Insert			AVERA GREGORY HOSPITAL P.O.BOX 408 GREGORY, SD 57533	12/5/2012 9:08 AM
Details	Comments Public	Insert			02/10/2012 added NPI#	2/10/2012 1:55 PM
Dates	Participating Approval Date	Update			9/1/2011 12:00:00 AM	9/1/2011 3:51 PM
Details	State	Update		Pending	Active	9/1/2011 3:51 PM
Details	340B ID	Update		NEXTQTR10	CAH431338-00	7/28/2011 4:25 PM
Details	Last Recertification Date	Insert				6/27/2011 12:13 PM
Details	Grant Number	Insert				6/27/2011 12:13 PM
Details	340B ID	Insert			NEXTQTR10	6/27/2011 12:13 PM
Details	Is Authorizing Official EHB Data	Insert				6/27/2011 12:13 PM
Dates	Last Date That 340B Drugs Purchased	Insert				6/27/2011 12:13 PM
Details	Medicare Provider Number	Insert			431338	6/27/2011 12:13 PM
Details	Entity Name	Insert			AVERA GREGORY HOSPITAL	6/27/2011 12:13 PM
Details	Program Code	Insert			CAH	6/27/2011 12:13 PM
Details	Entity Subname	Insert				6/27/2011 12:13 PM
Dates	Participating Approval Date	Insert				6/27/2011 12:13 PM
Details	State	Insert			Pending	6/27/2011 12:13 PM
Dates	Registration Date	Insert			5/5/2011 12:00:00 AM	6/27/2011 12:13 PM
Dates	Signed By Date	Insert			5/5/2011 12:00:00 AM	6/27/2011 12:13 PM
Dates	Start Date	Insert			10/1/2011 12:00:00 AM	6/27/2011 12:13 PM
Terminations	Termination Comments	Insert				6/27/2011 12:13 PM
Terminations	Termination Date	Insert				6/27/2011 12:13 PM
Terminations	Termination Effective Date	Insert				6/27/2011 12:13 PM
Terminations	Termination Reason	Insert				6/27/2011 12:13 PM