340B Drug Pricing Program Database
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CAH241348-00 AVERA TYLER (Active)
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Main Details
Name
AVERA TYLER
Subdivision Name
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH241348-00
Medicare Provider Number
241348
Additional Details
Current Program Status
Active
Registration Date
1/10/2013
Participating Start Date
4/1/2013
Participating Approval Date
3/5/2013
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
240 WILLOW STREET
TYLER, MN 56178
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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