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SCH430012-06 Sacred Heart Health Services DBA Avera Sacred Heart Hospital (Terminated)
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Main Details
Name
Sacred Heart Health Services DBA Avera Sacred Heart Hospital
Subdivision Name
Avera Medical Group Laflan
Type
Sole Community Hospital
Rural
Yes
340B ID
SCH430012-06
Medicare Provider Number
430012
Outpatient Facility Provider Number
288521
Additional Details
Current Program Status
Terminated
Registration Date
4/11/2014
Participating Start Date
7/1/2014
Participating Approval Date
6/13/2014
Last Recertification Date
11/21/2017
Termination Date
Termination Reason
1/1/2018
Hospital Outpatient facility no longer eligible
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
804 Chase Ave
Creighton, NE 68729
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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