| 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 | 4/7/2025 2:26 PM |
| Details | Last Recertification Date | Update | Recertification | 8/22/2023 12:03:31 AM | 8/19/2024 8:53:47 AM | 8/19/2024 8:53 AM |
| Addresses | Shipping Address | Insert | Change Request | | Platte Community Memorial Hospital, Inc
601 East 7th Street
Platte, SD 57369 | 10/17/2023 7:35 AM |
| Addresses | Shipping Address | Insert | Change Request | | Avera Pharmacy Distribution Center
3820 N Potsdam Ave
Ste 3
Sioux Falls, SD 57104 | 10/17/2023 7:35 AM |
| Details | Last Recertification Date | Update | Recertification | 9/14/2022 7:05:31 AM | 8/22/2023 12:03:31 AM | 8/22/2023 12:03 AM |
| Details | Last Recertification Date | Update | Recertification | 8/26/2021 9:09:34 AM | 9/14/2022 7:05:31 AM | 9/14/2022 7:05 AM |
| Addresses | Main Address | Update | Recertification |
601 EAST 7TH
Platte, SD 57369 |
601 EAST 7TH STREET
Platte, SD 57369 | 8/26/2021 9:09 AM |
| Details | Last Recertification Date | Update | Recertification | 8/26/2020 2:44:04 PM | 8/26/2021 9:09:34 AM | 8/26/2021 9:09 AM |
| Details | Entity Name | Update | Recertification | Platte Community Memorial Hospital, Inc. DBA Platte Health Center Avera | Platte Community Memorial Hospital, Inc. | 8/26/2021 9:09 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 | 9/10/2019 11:34:35 AM | 8/26/2020 2:44:04 PM | 8/26/2020 2:44 PM |
| Details | Last Recertification Date | Update | Recertification | 8/28/2018 3:25:15 PM | 9/10/2019 11:34:35 AM | 9/10/2019 11:34 AM |
| Addresses | Main Address | Update | Recertification |
601 E 7th Street
Platte, SD 57369 |
601 EAST 7TH
Platte, SD 57369 | 8/28/2018 3:25 PM |
| Details | Last Recertification Date | Update | Recertification | 11/21/2017 11:40:51 AM | 8/28/2018 3:25:15 PM | 8/28/2018 3:25 PM |
| Contacts | Primary Contact | Update | Recertification | Sternberg, Jody
Dir of Pt care
6053373364 | Friesen, Brandy
340b Coordinator
Avera
6053228446 | 11/21/2017 11:40 AM |
| Details | Last Recertification Date | Update | Recertification | 8/16/2016 12:00:00 AM | 11/21/2017 11:40:51 AM | 11/21/2017 11:40 AM |
| Contacts | Authorizing Official | Update | | Burket, Mark
CEO
6053373364 | Burket, Mark
CEO
Platte Community Memoria Hospial Inc
6053373364 | 11/21/2017 11:07 AM |
| Contacts | Signed By | Update | | Burket, Mark
CEO
6053373364 | Burket, Mark
CEO
Platte Community Memoria Hospial Inc
6053373364 | 11/21/2017 11:07 AM |
| Addresses | Main Address | Insert | | |
601 E 7th Street
Platte, SD 57369 | 6/30/2017 7:55 PM |
| Addresses | Billing Address | Insert | | | Platte Health Center Avera
601 E 7th Street
PO Box 200
Platte, SD 57369 | 6/30/2017 7:55 PM |
| Contacts | Primary Contact | Insert | | | Sternberg, Jody
Dir of Pt care
6053373364 | 6/30/2017 7:55 PM |
| Contacts | Authorizing Official | Insert | | | Burket, Mark
CEO
6053373364 | 6/30/2017 7:55 PM |
| Contacts | Signed By | Insert | | | Burket, Mark
CEO
6053373364 | 6/30/2017 7:55 PM |
| Details | Last Recertification Date | Update | | 8/11/2015 12:00:00 AM | 8/16/2016 12:00:00 AM | 8/16/2016 9:31 AM |
| Details | Last Recertification Date | Update | | 8/6/2014 12:00:00 AM | 8/11/2015 12:00:00 AM | 8/11/2015 11:17 AM |
| Details | Last Recertification Date | Update | | 8/30/2013 12:00:00 AM | 8/6/2014 12:00:00 AM | 8/6/2014 12:15 PM |
| Details | Last Recertification Date | Update | | 8/30/2013 12:57:16 PM | 8/30/2013 12:00:00 AM | 9/27/2013 10:43 AM |
| Details | Last Recertification Date | Update | | | 8/30/2013 12:57:16 PM | 8/30/2013 12:57 PM |
| Details | 340B ID | Update | | ISBLCAH431306-00 | CAH431306-00 | 2/14/2013 9:59 AM |
| Dates | Participating Approval Date | Update | | | 2/14/2013 12:00:00 AM | 2/14/2013 9:59 AM |
| Details | State | Update | | Pending | Active | 2/14/2013 9:59 AM |
| Dates | Start Date | Update | | | 4/1/2013 12:00:00 AM | 2/14/2013 9:59 AM |
| Details | Comments Public | Insert | | | 020813 - Recommend approval documentation received. | 2/8/2013 6:03 PM |
| Details | 340B ID | Update | | BL010413 | ISBLCAH431306-00 | 2/8/2013 6:02 PM |
| Details | 340B ID | Update | | ONLINE_REG | BL010413 | 1/4/2013 2:57 PM |
| Details | Last Recertification Date | Insert | | | | 1/3/2013 12:21 PM |
| Details | Grant Number | Insert | | | | 1/3/2013 12:21 PM |
| Details | 340B ID | Insert | | | ONLINE_REG | 1/3/2013 12:21 PM |
| Details | Is Authorizing Official EHB Data | Insert | | | | 1/3/2013 12:21 PM |
| Dates | Last Date That 340B Drugs Purchased | Insert | | | | 1/3/2013 12:21 PM |
| Details | Medicare Provider Number | Insert | | | 431306 | 1/3/2013 12:21 PM |
| Details | Entity Name | Insert | | | Platte Community Memorial Hospital, Inc. DBA Platte Health Center Avera | 1/3/2013 12:21 PM |
| Details | Program Code | Insert | | | CAH | 1/3/2013 12:21 PM |
| Details | Entity Subname | Insert | | | | 1/3/2013 12:21 PM |
| Dates | Participating Approval Date | Insert | | | | 1/3/2013 12:21 PM |
| Details | State | Insert | | | Pending | 1/3/2013 12:21 PM |
| Dates | Registration Date | Insert | | | 1/3/2013 12:00:00 AM | 1/3/2013 12:21 PM |
| Dates | Signed By Date | Insert | | | 1/3/2013 12:00:00 AM | 1/3/2013 12:21 PM |
| Dates | Start Date | Insert | | | | 1/3/2013 12:21 PM |
| Terminations | Termination Comments | Insert | | | | 1/3/2013 12:21 PM |
| Terminations | Termination Date | Insert | | | | 1/3/2013 12:21 PM |
| Terminations | Termination Effective Date | Insert | | | | 1/3/2013 12:21 PM |
| Terminations | Termination Reason | Insert | | | | 1/3/2013 12:21 PM |