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MILLER REXALL DRUG
CAH431337-00 AVERA HAND COUNTY MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
AVERA HAND COUNTY MEMORIAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH431337-00
Entity Address
300 W 5TH ST
MILLER, SD 57362
Medicare Provider Number
431337
Participating Start Date
9/30/2010
Last Recertification Date
8/22/2024
Pharmacy Details
Pharmacy Name
MILLER REXALL DRUG
Pharmacy Address
209 N BROADWAY AVE
MILLER, SD 57362
Pharmacy Comments
Contract Details
Approval Date
12/30/2011
Contract Begin Date
12/30/2011
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
DAVE KAPASKA, REGIONAL PRESIDENT/CEO
(605) 322-7808
Contract Pharmacy Representative
TRENT MERKWAN, OWNER/PRESIDENT
(605) 853-3647
Signed By Date
11/30/2011
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