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DSH430016AN AVERA MCKENNAN (Active)
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Main Details
Name
AVERA MCKENNAN
Subdivision Name
Avera Medical Group Internal Medicine Women's Clinic
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH430016AN
Medicare Provider Number
430016
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
1/13/2015
Participating Start Date
4/1/2015
Participating Approval Date
3/4/2015
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
6215 South Cliff Ave
Suite 215
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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