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CAH161351-01 Avera Holy Family Health (Active)
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Main Details
Name
Avera Holy Family Health
Subdivision Name
AVERA MEDICAL GROUP ESTHERVILLE
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH161351-01
Medicare Provider Number
161351
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
2/28/2011
Participating Start Date
4/1/2011
Participating Approval Date
3/16/2011
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
926 N. 8TH STREET
ESTHERVILLE, IA 51334
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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7/9/12 THIS RECORD WAS INADVERTENTLY OVERWRITTEN WITH THE DATA FOR CAH431331-01 ON 7/25/2011, THE CORRECT VALUES WERE RESTORED IN JUNE 2012. THIS OUTPATIENT CLINIC WAS CONTINUOUSLY ELIGIBLE FOR 340B DISCOUNTS FROM 7/25/2011 THRU JUNE 2012 DESPITE NOT BEING LISTED IN THE 340B DATABASE DURING THIS PERIOD.
07/09/2012
7/25/11 updated name(was AVERA MCKENNAN DBA AVERA COLTON MEDICAL CLINIC)
07/25/2011
April 2025
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