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DSH430016X AVERA MCKENNAN (Active)
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Main Details
Name
AVERA MCKENNAN
Subdivision Name
Avera Medical Group Pediatrics - Marion Rd.
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH430016X
Medicare Provider Number
430016
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
2/7/2013
Participating Start Date
4/1/2013
Participating Approval Date
2/28/2013
Last Recertification Date
8/28/2024
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
2100 S MARION RD
STE 205
SIOUX FALLS, SD 57106
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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April 2025
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