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CAH431338-01 Avera McKennan dba Avera Gregory Hospital (Terminated)
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Main Details
Name
Avera McKennan dba Avera Gregory Hospital
Subdivision Name
AVERA MEDICAL GROUP-GREGORY
Type
Critical Access Hospital
Rural
No
340B ID
CAH431338-01
Medicare Provider Number
431338
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
9/27/2011
Participating Start Date
10/1/2011
Participating Approval Date
9/27/2011
Last Recertification Date
9/16/2022
Termination Date
Termination Reason
4/1/2023
Outpatient facility moved within the 4 walls of the parent hospital
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
405 WHITTECAR
GREGORY, SD 57533
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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June 2025
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