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STEFFEN DRUG STORE
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
STEFFEN DRUG STORE
Pharmacy Address
214 N BROADWAY AVE
PO BOX 248
HARTINGTON, NE 68739-0248
Pharmacy Comments
Contract Details
Approval Date
4/12/2013
Contract Begin Date
7/1/2013
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2020
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Jamie Schaefer, CFO
(605) 668-8776
Contract Pharmacy Representative
Steffen Drug
MATT STEFFEN, OWNER/PHARMACIST
(402) 254-3549
Signed By Date
4/12/2013
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