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GREGORY DRUG
CAH431338-00 Avera McKennan dba Avera Gregory Hospital
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Covered Entity Details
Entity Name
Avera McKennan dba Avera Gregory Hospital
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH431338-00
Entity Address
110 S. Logan Ave
Gregory, SD 57533
Medicare Provider Number
431338
Participating Start Date
10/1/2011
Last Recertification Date
8/28/2024
Pharmacy Details
Pharmacy Name
GREGORY DRUG
Pharmacy Address
604 MAIN ST
GREGORY, SD 57533
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
Winner Health Mart
Dan Fiebelkorn, Owner
(605) 385-3541
Signed By Date
11/30/2011
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