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CAH161351-00 Avera Holy Family Health (Active)
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Main Details
Name
Avera Holy Family Health
Subdivision Name
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH161351-00
Medicare Provider Number
161351
Additional Details
Current Program Status
Active
Registration Date
9/30/2010
Participating Start Date
9/30/2010
Participating Approval Date
9/30/2010
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
826 N 8TH ST
ESTHERVILLE, IA 51334
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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7/25/11 updated name(was AVERA HOLY FAMILY HEALTH) 10/22/2010- UPDATED ADD (WAS 826 N. 8 ST.) 9/21/11-added NPI #
09/21/2011
7/25/11 updated name(was AVERA HOLY FAMILY HEALTH) 10/22/2010- UPDATED ADD (WAS 826 N. 8 ST.)
07/25/2011
10/22/2010- UPDATED ADD (WAS 826 N. 8 ST.)
12/07/2010
February 2025
February 2025
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