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CAH431338-00 Avera McKennan dba Avera Gregory Hospital (Active)
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Main Details
Name
Avera McKennan dba Avera Gregory Hospital
Subdivision Name
Type
Critical Access Hospital
Rural
No
340B ID
CAH431338-00
Medicare Provider Number
431338
Additional Details
Current Program Status
Active
Registration Date
5/5/2011
Participating Start Date
10/1/2011
Participating Approval Date
9/1/2011
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
110 S. Logan Ave
Gregory, SD 57533
Billing Address
AVERA GREGORY HOSPITAL
P.O.BOX 408
GREGORY, SD 57533
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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02/10/2012 added NPI#
02/10/2012
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