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DSH430016C AVERA MCKENNAN (Active)
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Main Details
Name
AVERA MCKENNAN
Subdivision Name
Avera Medical Group Hematology, Transplant & Cellular Therapy
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH430016C
Medicare Provider Number
430016
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
12/15/2008
Participating Start Date
1/1/2009
Participating Approval Date
12/15/2008
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
1000 E 23RD ST
STE 200
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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3/27/12 UPDATED SUBDIV NAME (WAS AVERA MEDICAL HEMATOLOGY AND TRANSPLANT); 9/17/08 DOC RECD TO CONFIRM ELIG DSH ADJ. 11/19/10 UPDATED SUBDIVISION NAME(WAS AVERA HEMATOLOGY AND TRANSPLANT, AVERA CANCER INSTITUTE)AND ADDR.(WAS 1000 E.21ST)
03/27/2012
9/17/08 DOC RECD TO CONFIRM ELIG DSH ADJ. 11/19/10 UPDATED SUBDIVISION NAME(WAS AVERA HEMATOLOGY AND TRANSPLANT, AVERA CANCER INSTITUTE)AND ADDR.(WAS 1000 E.21ST)
11/19/2010
April 2025
April 2025
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