Covered Entity Details

SCH430012-00 AVERA SACRED HEART HOSPITAL (Terminated)

Main Details

Name

AVERA SACRED HEART HOSPITAL

Subdivision Name

Type

Sole Community Hospital

Rural

Yes

340B ID

SCH430012-00

Medicare Provider Number

430012

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

8/28/2023

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

501 SUMMIT ST
YANKTON, SD 57078

Billing Address
Same as Street Address

Comment	Last Updated On
1 Item 1 to 6 of 6 Page: of 1 Page size:

1 Item 1 to 6 of 6 Page: of 1 Page size:
Participating Start Date 4/1/2021, Termination Date 4/1/2022, Reinstatement 04/21/2022	04/21/2022
Participating Start Date 4/1/2021, Termination Date 4/1/2022, Reinstatement 7/1/2022	04/14/2022
Participating starting 4/1/2013; Terminated 1/1/2020; Reinstated 4/1/2021.	03/03/2021
3/18/13 participating 9/22/10 thru 3/31/12, not participating 4/1/12 thru 3/31/13, record reinstated based on new registration submitted and electronically signed by Jamie Schaefer on 1/14/13;; 01/12/12 - added NPI #	03/19/2013
3/18/13 participating 9/22/10 thru 3/31/12, not participating 4/1/12 thru 3/31/13; 01/12/12 - added NPI #	03/18/2013
01/12/12 - added NPI #	01/12/2012

340B Drug Pricing Program Database