Covered Entity Details

CAH161336-00 Hegg Memorial Hospital (Active) - information as of 6/9/2025 12:01:21 AM

Main Details

Name

Hegg Memorial Hospital

Subdivision Name

Type

Critical Access Hospital

Rural

Yes

340B ID

CAH161336-00

Medicare Provider Number

161336

Additional Details

Current Program Status

Active

Registration Date

8/30/2011

Participating Start Date

10/1/2011

Participating Approval Date

9/22/2011

Last Recertification Date

8/12/2024

Contacts

Authorizing Official

Hegg Memorial Hospital
Glenn Zevenbergen, CEO
(712) 476-8009

Primary Contact

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

Addresses

Street Address

1202 21st Ave
Rock Valley, IA 51247

Billing Address

Hegg Memorial Hospital
1200 21st Ave
Rock Valley, IA 51247

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History

Comments

Comment	Last Updated On
No records to display.

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

Hegg Memorial Hospital
1200 21st Ave
Rock Valley, IA 51247

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	AVERA SPECIALTY PHARMACY	500 E 56TH ST N STE 3150		SIOUX FALLS	SD	57104	01/09/2023	01/17/2023		01/17/2023
Contract Detail	HULL PHARMACY	ATTN RICHARD DYKSTRA	1044 MAIN STREET BOX 309	HULL	IA	51239	11/29/2012	11/29/2012	08/31/2016	02/20/2017
Contract Detail	HY-VEE PHARMACY	1951 S MAIN		SIOUX CENTER	IA	51250	11/07/2011	11/07/2011	07/28/2016	07/28/2016
Contract Detail	LEWIS DRUG #1	2901 S MINNESOTA AVE		SIOUX FALLS	SD	57105	04/15/2013	07/01/2013	02/20/2017	02/20/2017
Contract Detail	LEWIS DRUG #10	6109 S LOUISE AVE		SIOUX FALLS	SD	57108	04/15/2013	07/01/2013	02/20/2017	02/20/2017
Contract Detail	LEWIS DRUG #11	1301 E 10TH ST	SUITE 100	SIOUX FALLS	SD	57103	04/15/2013	07/01/2013	02/20/2017	02/20/2017
Contract Detail	LEWIS DRUG #12	910 22ND AVE S		BROOKINGS	SD	57006-2830	04/15/2013	07/01/2013	02/20/2017	02/20/2017
Contract Detail	LEWIS DRUG #13	720 E 1ST ST		TEA	SD	57064	04/15/2013	07/01/2013	02/20/2017	02/20/2017
Contract Detail	LEWIS DRUG #2	2700 W 12TH ST		SIOUX FALLS	SD	57104-3701	04/15/2013	07/01/2013	02/20/2017	02/20/2017
Contract Detail	LEWIS DRUG #3	1301 E 10TH ST		SIOUX FALLS	SD	57103-1780	04/15/2013	07/01/2013	02/20/2017	02/20/2017
Contract Detail	LEWIS DRUG #5	741 S WASHINGTON AVE		MADISON	SD	57042-3409	04/15/2013	07/01/2013	02/20/2017	02/20/2017
Contract Detail	LEWIS DRUG #6	5500 W 41ST ST		SIOUX FALLS	SD	57106-1009	04/15/2013	07/01/2013	02/20/2017	02/20/2017
Contract Detail	LEWIS DRUG #7	4409 E 26TH ST		SIOUX FALLS	SD	57103	04/15/2013	07/01/2013	02/20/2017	02/20/2017
Contract Detail	LEWIS DRUG #9	115 SPLITROCK BLVD	PO BOX 527	BRANDON	SD	57005	04/15/2013	07/01/2013	02/20/2017	02/20/2017
Contract Detail	LEWIS DRUG DISTRIBUTION CENTER	700 E 54TH ST N		SIOUX FALLS	SD	57104	07/06/2012	07/06/2012		03/28/2013
Contract Detail	LEWIS FAMILY DRUG #39	521 BLACK FOREST RD	STE 5	HULL	IA	51239	01/04/2017	04/01/2017		01/04/2017
Contract Detail	LEWIS FAMILY DRUG #51	202 S KNISS AVE		LUVERNE	MN	56156-1775	04/15/2013	07/01/2013	02/20/2017	02/20/2017
Contract Detail	LEWIS FAMILY DRUG #54	LEWIS FAMILY DRUG LLC	2202 17TH ST	SPIRIT LAKE	IA	51360	04/15/2013	07/01/2013	02/20/2017	02/20/2017
Contract Detail	LEWIS FAMILY DRUG #56	LEWIS FAMILY DRUG, LLC	599 2ND AVE N	WINDOM	MN	56101-1927	04/15/2013	07/01/2013	02/20/2017	02/20/2017
Contract Detail	LEWIS FAMILY DRUG #59	LEWIS FAMILY DRUG, LLC	143 S MAIN AVE	SIOUX CENTER	IA	51250-1535	04/15/2013	07/01/2013	02/20/2017	02/20/2017
Contract Detail	LEWIS FAMILY DRUG #60	LEWIS FAMILY DRUG, LLC	715 E 5TH ST PO BOX 291	CANTON	SD	57013-1829	04/15/2013	07/01/2013	02/20/2017	02/20/2017
Contract Detail	LEWIS FAMILY DRUG #61	LEWIS FAMILY DRUG LLC	106 N BOONE ST	ROCK RAPIDS	IA	51246-1537	04/15/2013	07/01/2013	02/20/2017	02/20/2017
Contract Detail	LEWIS FAMILY DRUG #63	515 N PINE ST		LENNOX	SD	57039-2188	04/15/2013	07/01/2013	02/20/2017	02/20/2017
Contract Detail	LEWIS FAMILY DRUG #65	LEWIS FAMILY DRUG, LLC	6110 S MINNESOTA AVE.	SIOUX FALLS	SD	57108	04/15/2013	07/01/2013	02/20/2017	02/20/2017
Contract Detail	LEWIS FAMILY DRUG #66	911 W CEDAR ST STE 1		BERESFORD	SD	57004-1608	04/15/2013	07/01/2013	02/20/2017	02/20/2017
Contract Detail	LEWIS FAMILY DRUG #68	111 CALUMET AVE SW		DE SMET	SD	57231	04/15/2013	07/01/2013	02/20/2017	02/20/2017
Contract Detail	LEWIS FAMILY DRUG #69	1227 VALLEY DR		ROCK VALLEY	IA	51247-1552	05/29/2012	05/29/2012		03/28/2013

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
CAH161336-01	Child	CAH	Hegg Memorial Hospital	Hegg Medical Clinic Avera	1200 21st Avenue	Rock Valley	IA	Terminated

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
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	8/22/2023 3:59:03 PM	8/12/2024 3:18:17 PM	8/12/2024 3:18 PM
Addresses	Shipping Address	Insert	Change Request		Avera Pharmacy Distribution Center 3820 N Potsdam Ave Ste 3 Sioux Falls, SD 57104	10/10/2023 6:41 AM
Addresses	Billing Address	Insert	Recertification		Hegg Memorial Hospital 1200 21st Ave Rock Valley, IA 51247	8/22/2023 3:59 PM
Addresses	Shipping Address	Insert	Recertification		Hegg Memorial Hospital 1200 21st Ave Rock Valley, IA 51247	8/22/2023 3:59 PM
Addresses	Main Address	Update	Recertification	1200 21st Ave Rock Valley, IA 51247	1202 21st Ave Rock Valley, IA 51247	8/22/2023 3:59 PM
Details	Last Recertification Date	Update	Recertification	9/14/2022 12:05:53 PM	8/22/2023 3:59:03 PM	8/22/2023 3:59 PM
Details	Last Recertification Date	Update	Recertification	8/23/2021 10:41:26 AM	9/14/2022 12:05:53 PM	9/14/2022 12:05 PM
Details	Last Recertification Date	Update	Recertification	8/20/2020 9:30:17 AM	8/23/2021 10:41:26 AM	8/23/2021 10:41 AM
Details	Entity Name	Update	Recertification	Hegg Memorial Hospital, Inc	Hegg Memorial Hospital	8/23/2021 10:41 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	8/22/2019 11:15:47 AM	8/20/2020 9:30:17 AM	8/20/2020 9:30 AM
Addresses	Main Address	Update	Recertification	1200 21st Avenue Rock Valley, IA 51247	1200 21st Ave Rock Valley, IA 51247	8/22/2019 11:15 AM
Details	Last Recertification Date	Update	Recertification	8/28/2018 9:59:32 AM	8/22/2019 11:15:47 AM	8/22/2019 11:15 AM
Details	Entity Name	Update	Recertification	Hegg Memorial Hospital	Hegg Memorial Hospital, Inc	8/22/2019 11:15 AM
Details	Entity Name	Update	Change Request	Hegg Memorial Hospital, Inc	Hegg Memorial Hospital	12/31/2018 1:11 PM
Addresses	Main Address	Update	Recertification	1200 21st Ave Rock Valley, IA 51247	1200 21st Avenue Rock Valley, IA 51247	8/28/2018 9:59 AM
Details	Last Recertification Date	Update	Recertification	11/15/2017 11:48:39 AM	8/28/2018 9:59:32 AM	8/28/2018 9:59 AM
Details	Entity Name	Update	Recertification	Hegg Memorial Hospital	Hegg Memorial Hospital, Inc	8/28/2018 9:59 AM
Contacts	Primary Contact	Insert	Recertification		Friesen, Brandy 340b Coordinator Avera 6053228446	11/15/2017 11:48 AM
Details	Last Recertification Date	Update	Recertification	8/15/2016 12:00:00 AM	11/15/2017 11:48:39 AM	11/15/2017 11:48 AM
Contacts	Authorizing Official	Update		Zevenbergen, Glenn CEO 7124768009	Zevenbergen, Glenn CEO Hegg Memorial Hospital 7124768009	10/19/2017 4:40 PM
Contacts	Signed By	Update		Zevenbergen, Glenn CEO 7124768009	Zevenbergen, Glenn CEO Hegg Memorial Hospital 7124768009	10/19/2017 4:40 PM
Contacts	Authorizing Official	Insert			Zevenbergen, Glenn CEO 7124768009	2/20/2017 2:43 PM
Contacts	Signed By	Insert			Zevenbergen, Glenn CEO 7124768009	2/20/2017 2:43 PM
Addresses	Main Address	Insert			1200 21st Ave Rock Valley, IA 51247	8/15/2016 9:09 AM
Details	Last Recertification Date	Update		8/7/2015 12:00:00 AM	8/15/2016 12:00:00 AM	8/15/2016 9:09 AM
Details	Last Recertification Date	Update		8/6/2014 12:00:00 AM	8/7/2015 12:00:00 AM	8/7/2015 10:08 AM
Details	Last Recertification Date	Update		8/19/2013 12:00:00 AM	8/6/2014 12:00:00 AM	8/6/2014 9:53 AM
Addresses	Shipping Address	Delete		1200 21st Ave Rock Valley, IA 51247		8/22/2013 1:40 PM
Addresses	Shipping Address	Insert			1200 21st Ave Rock Valley, IA 51247	8/22/2013 1:40 PM
Details	Last Recertification Date	Update		8/19/2013 11:59:34 AM	8/19/2013 12:00:00 AM	8/21/2013 2:27 PM
Details	Last Recertification Date	Update			8/19/2013 11:59:34 AM	8/19/2013 11:59 AM
Dates	Participating Approval Date	Update			9/22/2011 12:00:00 AM	9/22/2011 5:28 PM
Details	State	Update		Pending	Active	9/22/2011 5:28 PM
Dates	Start Date	Update			10/1/2011 12:00:00 AM	9/15/2011 9:43 AM
Details	340B ID	Update		ONLINE_REG	CAH161336-00	9/13/2011 1:32 AM
Details	Last Recertification Date	Insert				8/30/2011 3:59 PM
Details	Grant Number	Insert				8/30/2011 3:59 PM
Details	340B ID	Insert			ONLINE_REG	8/30/2011 3:59 PM
Details	Is Authorizing Official EHB Data	Insert				8/30/2011 3:59 PM
Dates	Last Date That 340B Drugs Purchased	Insert				8/30/2011 3:59 PM
Details	Medicare Provider Number	Insert			161336	8/30/2011 3:59 PM
Details	Entity Name	Insert			Hegg Memorial Hospital	8/30/2011 3:59 PM
Details	Program Code	Insert			CAH	8/30/2011 3:59 PM
Details	Entity Subname	Insert				8/30/2011 3:59 PM
Dates	Participating Approval Date	Insert				8/30/2011 3:59 PM
Details	State	Insert			Pending	8/30/2011 3:59 PM
Dates	Registration Date	Insert			8/30/2011 12:00:00 AM	8/30/2011 3:59 PM
Dates	Signed By Date	Insert			8/30/2011 12:00:00 AM	8/30/2011 3:59 PM
Dates	Start Date	Insert				8/30/2011 3:59 PM
Terminations	Termination Comments	Insert				8/30/2011 3:59 PM
Terminations	Termination Date	Insert				8/30/2011 3:59 PM
Terminations	Termination Effective Date	Insert				8/30/2011 3:59 PM
Terminations	Termination Reason	Insert				8/30/2011 3:59 PM