Covered Entity Details

SCH430012-12 AVERA SACRED HEART HOSPITAL (Terminated) - information as of 4/29/2025 11:52:36 PM

Main Details

Name

AVERA SACRED HEART HOSPITAL

Subdivision Name

Avera Medical Group Behavioral Health Yankton

Type

Sole Community Hospital

Rural

Yes

340B ID

SCH430012-12

Medicare Provider Number

430012

Outpatient Facility Provider Number

Additional Details

Current Program Status

Terminated

Registration Date

4/13/2022

Participating Start Date

4/21/2022

Participating Approval Date

4/21/2022

Last Recertification Date

8/20/2023

Termination Date
Termination Reason

1/1/2024
DSH percentage below statutory minimum

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

409 Summit
#3200
Yankton, SD 57078

Billing Address

Avera Sacred Heart Hospital
501 Summit
Yankton, SD 57078

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History

Comments

Comment	Last Updated On
Participating Start Date 4/1/2021, Termination Date 4/1/2022, Reinstatement 4/21/2022	04/21/2022
Participating Start Date 4/1/2021, Termination Date 4/1/2022, Reinstatement 7/1/2022	04/14/2022
Participating from effective date: (07/01/2019) until terminated effective date: (1/1/2020), reinstatement effective date: (04/01/2021).	01/13/2021

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 Sacred Heart Hospital
501 Summit
Yankton, SD 57078

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Carve-In Effective Date	Termination Date	Last Updated On
No records to display.

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
SCH430012-01	Child	SCH	Sacred Heart Health Services DBA Avera Sacred Heart Hospital	Avera Medical Group Hartington	405 West Darlene St	HARTINGTON	NE	Terminated
SCH430012-02	Child	SCH	Sacred Heart Health Services DBA Avera Sacred Heart Hospital	Avera Medical Group Crofton	203 West Main	Crofton	NE	Terminated
SCH430012-03	Child	SCH	Sacred Heart Health Services DBA Avera Sacred Heart Hospital	Avera Medical Group Niobrara	254-10 Park Ave E	NIOBRARA	NE	Terminated
SCH430012-05	Child	SCH	Sacred Heart Health Services DBA Avera Sacred Heart Hospital	Avera Medical Group Verdigre	401 James Street	Verdigre	NE	Terminated
SCH430012-06	Child	SCH	Sacred Heart Health Services DBA Avera Sacred Heart Hospital	Avera Medical Group Laflan	804 Chase Ave	Creighton	NE	Terminated
SCH430012-07	Child	SCH	Sacred Heart Health Services DBA Avera Sacred Heart Hospital	Avera Medical Group Pierce	503 N 6th St	Pierce	NE	Terminated
SCH430012-08	Child	SCH	AVERA SACRED HEART HOSPITAL	Avera Medical Group Family Medicine Yankton	2525 Fox Run Pkwy	Yankton	SD	Terminated
SCH430012-09	Child	SCH	AVERA SACRED HEART HOSPITAL	Avera Medical Group Podiatry Yankton	409 Summit	Yankton	SD	Terminated
SCH430012-10	Child	SCH	AVERA SACRED HEART HOSPITAL	Avera Medical Group Pain Management Yankton	409 Summit St	Yankton	SD	Terminated
SCH430012-11	Child	SCH	AVERA SACRED HEART HOSPITAL	Avera Medical Group ENT Yankton	409 Summit	Yankton	SD	Terminated
SCH430012-12	Child	SCH	AVERA SACRED HEART HOSPITAL	Avera Medical Group Behavioral Health Yankton	409 Summit	Yankton	SD	Terminated
SCH430012-13	Child	SCH	AVERA SACRED HEART HOSPITAL	Avera Medical Group Palliative Medicine	409 Summit St	Yankton	SD	Terminated
SCH430012-14	Child	SCH	AVERA SACRED HEART HOSPITAL	Avera Medical Group Radiation Oncology Yankton	1115 W 9th St	Yankton	SD	Terminated

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	State	Update		To Be Terminated	Terminated	1/1/2024 12:01 AM
Dates	Last Date That 340B Drugs Purchased	Update	Termination Request		11/29/2023 12:00:00 AM	11/30/2023 4:33 PM
Details	State	Update	Termination Request	Active	To Be Terminated	11/30/2023 4:33 PM
Terminations	Termination Date	Update	Termination Request		1/1/2024 12:00:00 AM	11/30/2023 4:33 PM
Terminations	Termination Effective Date	Update	Termination Request		11/30/2023 12:00:00 AM	11/30/2023 4:33 PM
Terminations	Termination Reason	Update	Termination Request		DSH percentage below statutory minimum	11/30/2023 4:33 PM
Details	Last Recertification Date	Update	Recertification	9/16/2022 9:11:33 AM	8/20/2023 11:26:22 AM	8/20/2023 11:26 AM
Details	Last Recertification Date	Update	Recertification		9/16/2022 9:11:33 AM	9/16/2022 9:11 AM
Details	State	Update	OPA Edit	Approved	Active	4/21/2022 9:30 AM
Dates	Start Date	Update	OPA Edit	7/1/2022 12:00:00 AM	4/21/2022 12:00:00 AM	4/21/2022 9:30 AM
Addresses	Billing Address	Insert	Reinstatement		Avera Sacred Heart Hospital 501 Summit Yankton, SD 57078	4/21/2022 9:28 AM
Contacts	Signed By	Update	Reinstatement	Petersen, Steve Vice President of Pharmacy Avera 6053228313	Goff, Melissa Vice President - Pharmacy Avera 6053228548	4/21/2022 9:28 AM
Details	Last Recertification Date	Update	Reinstatement	8/27/2021 12:07:44 PM		4/21/2022 9:28 AM
Dates	Last Date That 340B Drugs Purchased	Update	Reinstatement	1/27/2022 12:00:00 AM		4/21/2022 9:28 AM
Details	Entity Name	Update	Reinstatement	SACRED HEART HEALTH SERVICES DBA AVERA SACRED HEART HOSPITAL	AVERA SACRED HEART HOSPITAL	4/21/2022 9:28 AM
Dates	Participating Approval Date	Update	Reinstatement	3/4/2021 8:26:52 AM	4/21/2022 9:28:44 AM	4/21/2022 9:28 AM
Details	State	Update	Reinstatement	Terminated	Approved	4/21/2022 9:28 AM
Dates	Registration Date	Update	Reinstatement	1/11/2021 4:15:00 PM	4/13/2022 2:30:14 PM	4/21/2022 9:28 AM
Dates	Signed By Date	Update	Reinstatement	1/12/2021 1:23:52 PM	4/13/2022 4:20:57 PM	4/21/2022 9:28 AM
Dates	Start Date	Update	Reinstatement	4/1/2021 12:00:00 AM	7/1/2022 12:00:00 AM	4/21/2022 9:28 AM
Terminations	Termination Date	Update	Reinstatement	4/1/2022 12:00:00 AM		4/21/2022 9:28 AM
Terminations	Termination Effective Date	Update	Reinstatement	1/28/2022 12:00:00 AM		4/21/2022 9:28 AM
Terminations	Termination Reason	Update	Reinstatement	DSH percentage below statutory minimum		4/21/2022 9:28 AM
Details	Comments Public	Insert	Reinstatement		Participating Start Date 4/1/2021, Termination Date 4/1/2022, Reinstatement 4/21/2022	4/21/2022 9:28 AM
Details	Comments Public	Insert	Reinstatement		Participating Start Date 4/1/2021, Termination Date 4/1/2022, Reinstatement 7/1/2022	4/14/2022 7:58 AM
Details	State	Update		To Be Terminated	Terminated	4/1/2022 12:01 AM
Dates	Last Date That 340B Drugs Purchased	Update	Termination Request		1/27/2022 12:00:00 AM	2/3/2022 9:56 AM
Details	State	Update	Termination Request	Active	To Be Terminated	2/3/2022 9:56 AM
Terminations	Termination Date	Update	Termination Request		4/1/2022 12:00:00 AM	2/3/2022 9:56 AM
Terminations	Termination Effective Date	Update	Termination Request		1/28/2022 12:00:00 AM	2/3/2022 9:56 AM
Terminations	Termination Reason	Update	Termination Request		DSH percentage below statutory minimum	2/3/2022 9:56 AM
Details	Last Recertification Date	Update	Recertification		8/27/2021 12:07:44 PM	8/27/2021 12:07 PM
Details	Entity Subname	Update	Recertification	AMG Behavioral Health - Psychiatry	Avera Medical Group Behavioral Health Yankton	8/27/2021 12:07 PM
Contacts	Authorizing Official	Update	Change Request	Petersen, Steve Vice President of Pharmacy Avera 6053228313	Goff, Melissa Vice President - Pharmacy Avera 6053228548	5/10/2021 5:20 PM
Details	Entity Name	Update	Change Request	AVERA SACRED HEART HOSPITAL	SACRED HEART HEALTH SERVICES DBA AVERA SACRED HEART HOSPITAL	5/7/2021 1:52 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	State	Update		Approved	Active	4/1/2021 12:01 AM
Addresses	Billing Address	Insert	Reinstatement		Avera Sacred Heart Hospital 501 Summit Yankton, SD 57078	3/4/2021 8:26 AM
Details	Last Recertification Date	Update	Reinstatement	8/22/2019 11:55:13 AM		3/4/2021 8:26 AM
Dates	Last Date That 340B Drugs Purchased	Update	Reinstatement	11/25/2019 12:00:00 AM		3/4/2021 8:26 AM
Details	Entity Name	Update	Reinstatement	Sacred Heart Health Services DBA Avera Sacred Heart Hospital	AVERA SACRED HEART HOSPITAL	3/4/2021 8:26 AM
Dates	Participating Approval Date	Update	Reinstatement	5/9/2019 8:33:35 AM	3/4/2021 8:26:52 AM	3/4/2021 8:26 AM
Details	State	Update	Reinstatement	Terminated	Approved	3/4/2021 8:26 AM
Dates	Registration Date	Update	Reinstatement	4/9/2019 1:42:55 PM	1/11/2021 4:15:00 PM	3/4/2021 8:26 AM
Dates	Signed By Date	Update	Reinstatement	5/8/2019 2:52:21 PM	1/12/2021 1:23:52 PM	3/4/2021 8:26 AM
Dates	Start Date	Update	Reinstatement	7/1/2019 12:00:00 AM	4/1/2021 12:00:00 AM	3/4/2021 8:26 AM
Terminations	Termination Date	Update	Reinstatement	1/1/2020 12:00:00 AM		3/4/2021 8:26 AM
Terminations	Termination Effective Date	Update	Reinstatement	11/25/2019 12:00:00 AM		3/4/2021 8:26 AM
Terminations	Termination Reason	Update	Reinstatement	DSH percentage below statutory minimum		3/4/2021 8:26 AM
Details	Comments Public	Insert	Reinstatement		Participating from effective date: (07/01/2019) until terminated effective date: (1/1/2020), reinstatement effective date: (04/01/2021).	1/13/2021 9:02 AM
Details	State	Update		To Be Terminated	Terminated	1/1/2020 12:05 AM
Dates	Last Date That 340B Drugs Purchased	Update	Termination Request		11/25/2019 12:00:00 AM	12/9/2019 4:20 PM
Details	State	Update	Termination Request	Active	To Be Terminated	12/9/2019 4:20 PM
Terminations	Termination Date	Update	Termination Request		1/1/2020 12:00:00 AM	12/9/2019 4:20 PM
Terminations	Termination Effective Date	Update	Termination Request		11/25/2019 12:00:00 AM	12/9/2019 4:20 PM
Terminations	Termination Reason	Update	Termination Request		DSH percentage below statutory minimum	12/9/2019 4:20 PM
Details	Last Recertification Date	Update	Recertification		8/22/2019 11:55:13 AM	8/22/2019 11:55 AM
Details	State	Update		Approved	Active	7/1/2019 12:05 AM
Contacts	Signed By	Insert	New Registration		Petersen, Steve Vice President of Pharmacy Avera 6053228313	5/9/2019 8:33 AM
Details	340B ID	Update	New Registration		SCH430012-12	5/9/2019 8:33 AM
Details	Entity Name	Update	New Registration	AVERA SACRED HEART HOSPITAL	Sacred Heart Health Services DBA Avera Sacred Heart Hospital	5/9/2019 8:33 AM
Details	Entity Subname	Update	New Registration	AMG Behavioral Health	AMG Behavioral Health - Psychiatry	5/9/2019 8:33 AM
Dates	Participating Approval Date	Update	New Registration		5/9/2019 8:33:35 AM	5/9/2019 8:33 AM
Details	State	Update	New Registration	Pending	Approved	5/9/2019 8:33 AM
Dates	Signed By Date	Update	New Registration		5/8/2019 2:52:21 PM	5/9/2019 8:33 AM
Dates	Start Date	Update	New Registration		7/1/2019 12:00:00 AM	5/9/2019 8:33 AM
Addresses	Main Address	Insert	New Registration		409 Summit #3200 Yankton, SD 57078	4/9/2019 1:42 PM
Addresses	Billing Address	Insert	New Registration		Avera Sacred Heart Hospital 501 Summit Yankton, SD 57078	4/9/2019 1:42 PM
Addresses	Shipping Address	Insert	New Registration		Avera Sacred Heart Hospital 501 Summit Yankton, SD 57078	4/9/2019 1:42 PM
Contacts	Authorizing Official	Insert	New Registration		Petersen, Steve Vice President of Pharmacy Avera 6053228313	4/9/2019 1:42 PM
Contacts	Primary Contact	Insert	New Registration		Friesen, Brandy 340b Coordinator Avera 6053228446	4/9/2019 1:42 PM
Details	Last Recertification Date	Insert	New Registration			4/9/2019 1:42 PM
Details	Grant Number	Insert	New Registration			4/9/2019 1:42 PM
Details	340B ID	Insert	New Registration			4/9/2019 1:42 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			4/9/2019 1:42 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			4/9/2019 1:42 PM
Details	Medicare Provider Number	Insert	New Registration		430012	4/9/2019 1:42 PM
Details	Entity Name	Insert	New Registration		AVERA SACRED HEART HOSPITAL	4/9/2019 1:42 PM
Details	Program Code	Insert	New Registration		SCH	4/9/2019 1:42 PM
Details	Entity Subname	Insert	New Registration		AMG Behavioral Health	4/9/2019 1:42 PM
Dates	Participating Approval Date	Insert	New Registration			4/9/2019 1:42 PM
Details	State	Insert	New Registration		Pending	4/9/2019 1:42 PM
Dates	Registration Date	Insert	New Registration		4/9/2019 1:42:55 PM	4/9/2019 1:42 PM
Dates	Signed By Date	Insert	New Registration			4/9/2019 1:42 PM
Dates	Start Date	Insert	New Registration			4/9/2019 1:42 PM
Terminations	Termination Comments	Insert	New Registration			4/9/2019 1:42 PM
Terminations	Termination Date	Insert	New Registration			4/9/2019 1:42 PM
Terminations	Termination Effective Date	Insert	New Registration			4/9/2019 1:42 PM
Terminations	Termination Reason	Insert	New Registration			4/9/2019 1:42 PM