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DSH430016K AVERA MCKENNAN (Active)
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Main Details
Name
AVERA MCKENNAN
Subdivision Name
Avera Medical Group Behavioral Health - Adult
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH430016K
Medicare Provider Number
430016
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
5/12/2009
Participating Start Date
7/1/2009
Participating Approval Date
5/26/2009
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
4400 W 69TH ST
STE 1500
SIOUX FALLS, SD 57108
Billing Address
AVERA MCKENNAN
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 UNIVERSITY PSYCHIATRY ASSOCIATES)
03/27/2012
April 2025
April 2025
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