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DSH430016R AVERA MCKENNAN HOSPITAL AND UNIVERSITY HEALTH CENTER (Terminated)
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Main Details
Name
AVERA MCKENNAN HOSPITAL AND UNIVERSITY HEALTH CENTER
Subdivision Name
Avera Medical Group McHale Institute
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH430016R
Medicare Provider Number
430016
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/9/2013
Participating Start Date
4/1/2013
Participating Approval Date
1/22/2013
Last Recertification Date
8/25/2016
Termination Date
Termination Reason
7/1/2017
Site closure
Contacts
Authorizing Official
Avera
Steve Petersen, Vice President of Pharmacy
(605) 322-8313
Primary Contact
Avera
Steve Petersen, Vice President of Pharmacy
(605) 322-8313
Addresses
Street Address
3720 W 69th Street # 1
Sioux Falls, SD 57108
Billing Address
Avera McKennan Hospital
PO BOX 5045
Sioux Falls, SD 57117
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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