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AVERA SPECIALTY PHARMACY
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
AVERA SPECIALTY PHARMACY
Pharmacy Address
500 E 56TH ST N STE 3150
SIOUX FALLS, SD 57104
Pharmacy Comments
5/4/11 UPDATED NAME AND ADDR (WAS AVERA DOCTORS PLAZA 2 PHARMACY, 1100 EAST 21ST STREET, SUITE 200)
Contract Details
Approval Date
1/10/2023
Contract Begin Date
1/17/2023
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
Avera McKennan
David Flicek, Avera McKennan President/CEO
(605) 322-7916
Signed By Date
1/10/2023
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