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DSH430016 AVERA MCKENNAN (Active)
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Main Details
Name
AVERA MCKENNAN
Subdivision Name
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH430016
Medicare Provider Number
430016
Additional Details
Current Program Status
Active
Registration Date
9/17/2008
Participating Start Date
9/18/2008
Participating Approval Date
9/18/2008
Last Recertification Date
9/5/2024
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
1325 S. CLIFF AVE.
SIOUX FALLS, SD 57105
Billing Address
Avera McKennan Hospital
PO BOX 5045
Sioux Falls, SD 57117
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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8/17/11 ADDED NPI #; 7/8/11 UPDATED ZIP (WAS 57117); 8/31/09 - DOC RECD TO CONFIRM ELIG DSH ADJ %;05/05/11 UPDATED ADDR.(WAS 800 EAST 21ST STREET)
08/17/2011
7/8/11 UPDATED ZIP (WAS 57117); 8/31/09 - DOC RECD TO CONFIRM ELIG DSH ADJ %;05/05/11 UPDATED ADDR.(WAS 800 EAST 21ST STREET)
07/08/2011
May 2025
May 2025
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