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CAH431315-00 WAGNER COMMUNITY MEMORIAL HOSPITAL (Active)
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Main Details
Name
WAGNER COMMUNITY MEMORIAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
Rural
No
340B ID
CAH431315-00
Medicare Provider Number
431315
Additional Details
Current Program Status
Active
Registration Date
8/10/2010
Participating Start Date
8/18/2010
Participating Approval Date
8/13/2010
Last Recertification Date
8/19/2024
Contacts
Authorizing Official
Wagner Community Memorial Hospital
Joshua Christensen, CFO
(605) 384-3611
Primary Contact
Avera
Brandy Friesen, Pharmacy Regulatory Analyst
(605) 322-8446
Addresses
Street Address
513 3RD ST SW
WAGNER, SD 57380
Billing Address
WAGNER COMMUNITY MEMORIAL HOSPITAL AVERA
P.O. BOX 280
WAGNER, SD 57380
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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