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WALGREEN CO.
SCH430012-00 AVERA SACRED HEART HOSPITAL
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Covered Entity Details
Entity Name
AVERA SACRED HEART HOSPITAL
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH430012-00
Entity Address
501 SUMMIT ST
YANKTON, SD 57078
Medicare Provider Number
430012
Participating Start Date
4/21/2022
Last Recertification Date
8/28/2023
Entity Termination Date
1/1/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 09806
2020 BROADWAY AVE
YANKTON, SD 57078
Pharmacy Comments
Contract Details
Approval Date
7/15/2022
Contract Begin Date
10/1/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2024
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Melissa Goff, Vice President - Pharmacy
(605) 322-8548
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/15/2022
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