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AVERA LONG-TERM CARE PHARMACY
CAH241359-00 AVERA MARSHALL
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Covered Entity Details
Entity Name
AVERA MARSHALL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH241359-00
Entity Address
300 S BRUCE STREET
MARSHALL, MN 56258-1934
Medicare Provider Number
241359
Participating Start Date
9/28/2010
Last Recertification Date
8/22/2024
Pharmacy Details
Pharmacy Name
AVERA LONG-TERM CARE PHARMACY
Pharmacy Address
AVERA MCKENNAN
4101 W MEMORY CIR STE 120
SIOUX FALLS, SD 57107
Pharmacy Comments
Contract Details
Approval Date
10/21/2015
Contract Begin Date
1/1/2016
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
SHARON WILLIAMS, VP OF FINANCE AND IT
(507) 537-9150
Contract Pharmacy Representative
Mark Gerdes, Pharmacy Manager
(605) 322-1447
Signed By Date
10/21/2015
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