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DSH430016AZ AVERA MCKENNAN (Active)
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Main Details
Name
AVERA MCKENNAN
Subdivision Name
Avera Medical Group Infectious Disease Specialists
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH430016AZ
Medicare Provider Number
430016
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
4/14/2020
Participating Start Date
4/17/2020
Participating Approval Date
4/17/2020
Last Recertification Date
8/26/2024
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
6709 S Minnesota Ave
Suite 102
Sioux Falls, SD 57108
Billing Address
Avera McKennan
PO Box 5045
Sioux Falls, SD 57117
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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