Covered Entity Details

DSH430077A RAPID CITY REGIONAL HOSPITAL (Terminated) - information as of 6/23/2025 12:34:15 AM

Main Details

Name

RAPID CITY REGIONAL HOSPITAL

Subdivision Name

Hospice House

Type

Disproportionate Share Hospital

Rural

340B ID

DSH430077A

Medicare Provider Number

430077

Outpatient Facility Provider Number

431501

Additional Details

Current Program Status

Terminated

Registration Date

7/24/2012

Participating Start Date

10/1/2012

Participating Approval Date

8/21/2012

Last Recertification Date

8/10/2016

Termination Date
Termination Reason

7/1/2017
For-Profit conversion

Contacts

Authorizing Official

Monument Health
Ruta Paulette Davidson, President & CEO
(605) 755-9130

Primary Contact

Regional Health
Dana Darger, Director of Pharmacy
(605) 755-8196

Addresses

Street Address

224 Elk St
Rapid City, SD 57701

Billing Address

Rapid City Regional Hospital
353 Fairmont Blvd
Rapid City, SD 57701

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History

Comments

Comment	Last Updated On
No records to display.

Medicaid Billing

At this site, will the covered entity bill Medicaid fee-for-service for drugs purchased at 340B prices?
No

Shipping Addresses

Shipping Address 1

Rapid City Regional Hospital
353 Fairmont Blvd
Rapid City, SD 57701

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Carve-In Effective Date	Termination Date	Last Updated On
No records to display.

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
DSH430077A	Child	DSH	RAPID CITY REGIONAL HOSPITAL	Hospice House	224 Elk St	Rapid City	SD	Terminated
DSH430077AA	Child	DSH	Monument Health Rapid City Hospital	MONUMENT HEALTH ORTHOPEDIC AND SPECIALTY HOSPITAL - PAIN MANAGEMENT	1635 CAREGIVER CIRCLE	Rapid City	SD	Active
DSH430077AB	Child	DSH	Monument Health Rapid City Hospital	MONUMENT HEALTH ORTHOPEDIC AND SPECIALTY HOSPITAL - HBO/WOUND CARE	2929 5th Street	RAPID CITY	SD	Active
DSH430077AC	Child	DSH	Monument Health Rapid City Hospital	MONUMENT HEALTH ORTHOPEDIC AND SPECIALTY HOSPITAL - SURGICAL SERVICES	1635 CAREGIVER CIRCLE	RAPID CITY	SD	Active
DSH430077AD	Child	DSH	Monument Health Rapid City Hospital	MONUMENT HEALTH ORTHOPEDIC AND SPECIALTY HOSPITAL - SPORTS MEDICINE	1635 CAREGIVER CIRCLE	RAPID CITY	SD	Active
DSH430077AE	Child	DSH	Monument Health Rapid City Hospital	MONUMENT HEALTH RAPID CITY HOSPITAL - WEIGHT MANAGEMENT	640 Flormann St.	RAPID CITY	SD	Active
DSH430077AF	Child	DSH	Monument Health Rapid City Hospital	MONUMENT HEALTH RAPID CITY CLINIC - FAIRMONT BLVD - GASTROENTEROLOGY - GASTROENTEROLOGY	353 Fairmont Blvd	Rapid City	SD	Active
DSH430077B	Child	DSH	Monument Health Rapid City Hospital	Monument Health Dialysis Center - Rapid City	955 East North St.	Rapid City	SD	Terminated
DSH430077C	Child	DSH	Monument Health Rapid City Hospital	Monument Health Dialysis Center - Spearfish	132 Yankee St	Spearfish	SD	Terminated
DSH430077D	Child	DSH	Monument Health Rapid City Hospital	Monument Health Heart and Vascular Institute	353 Fairmont Blvd.	Rapid City	SD	Active
DSH430077E	Child	DSH	Monument Health Rapid City Hospital	MONUMENT HEALTH FAMILY MEDICINE RESIDENCY CLINIC	502 E MONROE ST	RAPID CITY	SD	Active
DSH430077F	Child	DSH	Monument Health Rapid City Hospital	MONUMENT HEALTH NEUROLOGY AND REHABILITATION	677 Cathedral Dr.	RAPID CITY	SD	Active
DSH430077G	Child	DSH	Monument Health Rapid City Hospital	MONUMENT HEALTH BEHAVIORAL HEALTH CENTER	915 MOUNTAIN VIEW RD	RAPID CITY	SD	Active
DSH430077H	Child	DSH	Monument Health Rapid City Hospital	MONUMENT HEALTH RAPID CITY URGENT CARE - JACKSON BOULEVARD	2116 JACKSON BLVD	RAPID CITY	SD	Active
DSH430077J	Child	DSH	Monument Health Rapid City Hospital	MONUMENT HEALTH RAPID CITY URGENT CARE - LACROSSE STREET	1303 N. LACROSSE ST	RAPID CITY	SD	Active
DSH430077K	Child	DSH	Monument Health Rapid City Hospital	MONUMENT HEALTH RAPID CITY CLINIC - FLORMANN STREET - ENDOCRINOLOGY	640 FLORMANN ST	RAPID CITY	SD	Active
DSH430077L	Child	DSH	Monument Health Rapid City Hospital	MONUMENT HEALTH RAPID CITY CLINIC - FLORMANN STREET - INFECTIOUS DISEASE	640 FLORMANN ST	RAPID CITY	SD	Active
DSH430077M	Child	DSH	Monument Health Rapid City Hospital	MONUMENT HEALTH RAPID CITY CLINIC - FLORMANN STREET - NEPHROLOGY	640 FLORMANN ST	RAPID CITY	SD	Active
DSH430077N	Child	DSH	Monument Health Rapid City Hospital	MONUMENT HEALTH RAPID CITY CLINIC - FLORMANN STREET - PRIMARY CARE	640 FLORMANN ST	RAPID CITY	SD	Active
DSH430077P	Child	DSH	Monument Health Rapid City Hospital	MONUMENT HEALTH RAPID CITY CLINIC - FLORMANN STREET - PULMONOLOGY	640 FLORMANN ST	RAPID CITY	SD	Active
DSH430077Q	Child	DSH	Monument Health Rapid City Hospital	MONUMENT HEALTH RAPID CITY CLINIC - FLORMANN STREET - RHEUMATOLOGY	640 FLORMANN ST	RAPID CITY	SD	Active
DSH430077R	Child	DSH	Monument Health Rapid City Hospital	MONUMENT HEALTH RAPID CITY CLINIC - 5TH STREET - ENT	4150 5TH ST	RAPID CITY	SD	Active
DSH430077S	Child	DSH	Monument Health Rapid City Hospital	MONUMENT HEALTH RAPID CITY CLINIC - 5TH STREET - SURGERY	2805 5TH ST #100	RAPID CITY	SD	Active
DSH430077T	Child	DSH	Monument Health Rapid City Hospital	MONUMENT HEALTH ORTHOPEDIC AND SPECIALTY HOSPITAL - NEUROSURGERY	1635 CAREGIVER CIRCLE	RAPID CITY	SD	Active
DSH430077U	Child	DSH	Monument Health Rapid City Hospital	MONUMENT HEALTH RAPID CITY CLINIC - 5TH STREET - PLASTIC SURGERY	2805 5TH ST #100	RAPID CITY	SD	Active
DSH430077V	Child	DSH	Monument Health Rapid City Hospital	MONUMENT HEALTH ORTHOPEDIC AND SPECIALTY HOSPITAL - PODIATRY	1635 CAREGIVER CIRCLE	RAPID CITY	SD	Active
DSH430077W	Child	DSH	Monument Health Rapid City Hospital	MONUMENT HEALTH RAPID CITY CLINIC - 5TH STREET - UROLOGY	2805 5TH ST #100	RAPID CITY	SD	Active
DSH430077X	Child	DSH	Monument Health Rapid City Hospital	MONUMENT HEALTH SLEEP CENTER	2929 5th St. #210 A & B	Rapid City	SD	Active
DSH430077Y	Child	DSH	Monument Health Rapid City Hospital	MONUMENT HEALTH ORTHOPEDIC AND SPECIALTY HOSPITAL - ORTHOPEDIC SURGERY	1635 CAREGIVER CIRCLE	Rapid City	SD	Active
DSH430077Z	Child	DSH	Monument Health Rapid City Hospital	MONUMENT HEALTH RAPID CITY CLINIC - 5TH STREET - DERMATOLOGY	4150 5th Street	Rapid City	SD	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Authorizing Official	Update	AO Change Request	Davidson, Paulette Chief Operating Officer Regional Health 6057559138	Davidson, Ruta Paulette President & CEO Monument Health 6057559130	7/20/2020 1:40 PM
Contacts	Primary Contact	Update		Darger, Dana Director of Pharmacy 6057558196	Darger, Dana Director of Pharmacy Regional Health 6057558196	10/19/2017 4:22 PM
Contacts	Authorizing Official	Update	Change Request	Davidson, Paulette Chief Operating Officer 6057559138	Davidson, Paulette Chief Operating Officer Regional Health 6057559138	10/13/2017 11:25 AM
Contacts	Authorizing Official	Update		Phillips, Brent PRESIDENT & CEO 6057559130	Davidson, Paulette Chief Operating Officer 6057559138	7/12/2017 6:27 PM
Contacts	Signed By	Insert			HART, CHARLES E. PRESIDENT & CEO 6057198107	7/12/2017 1:59 PM
Contacts	Primary Contact	Insert			Darger, Dana Director of Pharmacy 6057558196	7/12/2017 1:59 PM
Addresses	Main Address	Insert			224 Elk St Rapid City, SD 57701	5/9/2017 11:13 AM
Addresses	Billing Address	Insert			Rapid City Regional Hospital 353 Fairmont Blvd Rapid City, SD 57701	5/9/2017 11:13 AM
Addresses	Shipping Address	Insert			Rapid City Regional Hospital 353 Fairmont Blvd Rapid City, SD 57701	5/9/2017 11:13 AM
Dates	Last Date That 340B Drugs Purchased	Update			11/1/2016 12:00:00 AM	5/9/2017 11:13 AM
Details	State	Update		Active	Terminated	5/9/2017 11:13 AM
Terminations	Termination Comments	Update			This site was moved to Regional Health Home Plus LLC, and is no longer eligible as a child site for Rapid City Regional Hospital.	5/9/2017 11:13 AM
Terminations	Termination Date	Update			7/1/2017 12:00:00 AM	5/9/2017 11:13 AM
Terminations	Termination Effective Date	Update			11/1/2016 12:00:00 AM	5/9/2017 11:13 AM
Terminations	Termination Reason	Update			For-Profit conversion	5/9/2017 11:13 AM
Details	Last Recertification Date	Update		8/5/2015 12:00:00 AM	8/10/2016 12:00:00 AM	8/10/2016 11:01 AM
Contacts	Authorizing Official	Insert			Phillips, Brent PRESIDENT & CEO 6057559130	8/5/2015 3:54 PM
Details	Last Recertification Date	Update		8/27/2014 12:00:00 AM	8/5/2015 12:00:00 AM	8/5/2015 3:54 PM
Details	Last Recertification Date	Update		9/9/2013 10:06:46 PM	8/27/2014 12:00:00 AM	8/27/2014 11:32 AM
Details	Last Recertification Date	Update			9/9/2013 10:06:46 PM	9/9/2013 10:06 PM
Details	340B ID	Update		IS-AP-DSH430077A	DSH430077A	8/21/2012 12:56 PM
Dates	Participating Approval Date	Update			8/21/2012 12:00:00 AM	8/21/2012 12:56 PM
Details	State	Update		Pending	Active	8/21/2012 12:56 PM
Dates	Start Date	Update			10/1/2012 12:00:00 AM	8/21/2012 12:56 PM
Details	340B ID	Update		AP080112A	IS-AP-DSH430077A	8/16/2012 10:29 AM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG	AP080112A	8/1/2012 7:42 AM
Details	Last Recertification Date	Insert				7/24/2012 12:13 PM
Details	Grant Number	Insert				7/24/2012 12:13 PM
Details	340B ID	Insert			OUTPATIENT_ONLINE_REG	7/24/2012 12:13 PM
Details	Is Authorizing Official EHB Data	Insert				7/24/2012 12:13 PM
Dates	Last Date That 340B Drugs Purchased	Insert				7/24/2012 12:13 PM
Details	Medicare Provider Number	Insert			430077	7/24/2012 12:13 PM
Details	Entity Name	Insert			RAPID CITY REGIONAL HOSPITAL	7/24/2012 12:13 PM
Details	Program Code	Insert			DSH	7/24/2012 12:13 PM
Details	Entity Subname	Insert			Hospice House	7/24/2012 12:13 PM
Dates	Participating Approval Date	Insert				7/24/2012 12:13 PM
Details	State	Insert			Pending	7/24/2012 12:13 PM
Dates	Registration Date	Insert			7/24/2012 12:00:00 AM	7/24/2012 12:13 PM
Dates	Signed By Date	Insert			7/24/2012 12:00:00 AM	7/24/2012 12:13 PM
Dates	Start Date	Insert				7/24/2012 12:13 PM
Terminations	Termination Comments	Insert				7/24/2012 12:13 PM
Terminations	Termination Date	Insert				7/24/2012 12:13 PM
Terminations	Termination Effective Date	Insert				7/24/2012 12:13 PM
Terminations	Termination Reason	Insert				7/24/2012 12:13 PM