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SENDERRA RX PHARMACY
DSH430016 AVERA MCKENNAN
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Covered Entity Details
Entity Name
AVERA MCKENNAN
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH430016
Entity Address
1325 S. CLIFF AVE.
SIOUX FALLS, SD 57105
Medicare Provider Number
430016
Participating Start Date
9/18/2008
Last Recertification Date
9/5/2024
Pharmacy Details
Pharmacy Name
SENDERRA RX PHARMACY
Pharmacy Address
SENDERRA RX PARTNERS, LLC
3712 E PLANO PKWY STE 200
PLANO, TX 75074
Pharmacy Comments
Contract Details
Approval Date
4/12/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/6/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Steve Petersen, Vice President of Pharmacy
(605) 322-8313
Contract Pharmacy Representative
Senderra RX Pharmacy
Galina Davis, VP Managed Care
(214) 446-9404
Signed By Date
4/12/2019
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