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CAH431338-02 Avera McKennan dba Avera Gregory Hospital (Active)
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Main Details
Name
Avera McKennan dba Avera Gregory Hospital
Subdivision Name
Avera Winner Medical Clinic
Type
Critical Access Hospital
Rural
No
340B ID
CAH431338-02
Medicare Provider Number
431338
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
9/27/2011
Participating Start Date
10/1/2011
Participating Approval Date
9/27/2011
Last Recertification Date
8/22/2024
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
660 W 2ND ST
WINNER, SD 57580
Billing Address
AVERA MEDICAL GROUP WINNER
660 W 2ND ST
PO BOX 705
WINNER, SD 57580
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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