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CAH431338-03 AVERA GREGORY HEALTHCARE CENTER (Terminated)
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Main Details
Name
AVERA GREGORY HEALTHCARE CENTER
Subdivision Name
AVERA MEDICAL GROUP - COLOME
Type
Critical Access Hospital
Rural
No
340B ID
CAH431338-03
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
11/20/2017
Termination Date
Termination Reason
10/1/2018
Site closure
Contacts
Authorizing Official
Avera
Steve Petersen, Vice President of Pharmacy
(605) 322-8313
Primary Contact
Avera
Brandy Friesen, Pharmacy Regulatory Analyst
(605) 322-8446
Addresses
Street Address
308 MAIN ST.
COLOME, SD 57528
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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