Contract Pharmacy Details

AVERA MCKENNAN
DSH430016 AVERA MCKENNAN

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

AVERA MCKENNAN

Pharmacy Address

DBA AVERA DERMATOLOGY PHARMACY
6701 S. MINNESOTA AVE
SIOUX FALLS, SD 57108

Pharmacy Comments

Contract Details

Approval Date

8/9/2011

Contract Begin Date

8/9/2011

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

12/7/2018
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

David Kapaska, PRESIDENT AND CEO
(605) 322-7808

Contract Pharmacy Representative

David Kapaska, PRESIDENT AND CEO
(605) 322-7808

Signed By Date

7/21/2011

340B Drug Pricing Program Database