Covered Entity Details

DSH430077N Monument Health Rapid City Hospital (Active) - information as of 5/10/2025 11:05:22 PM

Main Details

Name

Monument Health Rapid City Hospital

Subdivision Name

MONUMENT HEALTH RAPID CITY CLINIC - FLORMANN STREET - PRIMARY CARE

Type

Disproportionate Share Hospital

Rural

340B ID

DSH430077N

Medicare Provider Number

430077

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

10/9/2015

Participating Start Date

1/1/2016

Participating Approval Date

10/28/2015

Last Recertification Date

8/12/2024

Contacts

Authorizing Official

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

Primary Contact

Monument Health
Ryan Olivier, 340B Manager
(605) 366-6099

Addresses

Street Address

640 FLORMANN ST
RAPID CITY, SD 57701

Billing Address

Monument Health Rapid City 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

Monument Health Rapid City 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
Details	Last Recertification Date	Update	Recertification	8/20/2023 3:15:52 PM	8/12/2024 11:25:10 AM	8/12/2024 11:25 AM
Contacts	Primary Contact	Update	Group Change Request	Haupt, Kami 340B Supervisor Monument Health 6057557184	Olivier, Ryan 340B Manager Monument Health 6053666099	12/22/2023 8:23 AM
Details	Last Recertification Date	Update	Recertification	8/31/2022 4:19:26 PM	8/20/2023 3:15:52 PM	8/20/2023 3:15 PM
Details	Last Recertification Date	Update	Recertification	8/26/2021 2:46:56 PM	8/31/2022 4:19:26 PM	8/31/2022 4:19 PM
Details	Last Recertification Date	Update	Recertification	8/18/2020 12:54:47 PM	8/26/2021 2:46:56 PM	8/26/2021 2:46 PM
Details	Last Recertification Date	Update	Recertification	8/21/2019 9:17:09 PM	8/18/2020 12:54:47 PM	8/18/2020 12:54 PM
Addresses	Shipping Address	Delete	Change Request	Regional Health Rapid City Hospital 353 Fairmont Blvd. Rapid City, SD 57701		8/14/2020 2:19 PM
Addresses	Billing Address	Update	Change Request	Regional Health Rapid City Hospital 353 Fairmont Blvd. Rapid City, SD 57701	Monument Health Rapid City Hospital 353 Fairmont Blvd. Rapid City, SD 57701	8/14/2020 2:19 PM
Addresses	Shipping Address	Insert	Change Request		Monument Health Rapid City Hospital 353 Fairmont Blvd. Rapid City, SD 57701	8/14/2020 2:19 PM
Contacts	Primary Contact	Update	Change Request	Haupt, Kami 340B Supervisor Regional Health 6057557184	Haupt, Kami 340B Supervisor Monument Health 6057557184	8/14/2020 2:19 PM
Details	Entity Subname	Update	Change Request	REGIONAL HEALTH MEDICAL CLINIC FLORMANN STREET - PRIMARY CARE	MONUMENT HEALTH RAPID CITY CLINIC - FLORMANN STREET - PRIMARY CARE	8/14/2020 2:19 PM
Details	Entity Name	Update	Change Request	Regional Health Rapid City Hospital	Monument Health Rapid City Hospital	7/28/2020 9:39 AM
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
Addresses	Billing Address	Insert	Recertification		Regional Health Rapid City Hospital 353 Fairmont Blvd. Rapid City, SD 57701	8/21/2019 9:17 PM
Addresses	Shipping Address	Insert	Recertification		Regional Health Rapid City Hospital 353 Fairmont Blvd. Rapid City, SD 57701	8/21/2019 9:17 PM
Details	Last Recertification Date	Update	Recertification	8/16/2018 11:33:52 AM	8/21/2019 9:17:09 PM	8/21/2019 9:17 PM
Details	Last Recertification Date	Update	Recertification	11/29/2017 8:45:56 PM	8/16/2018 11:33:52 AM	8/16/2018 11:33 AM
Details	Last Recertification Date	Update	Recertification	8/10/2016 12:00:00 AM	11/29/2017 8:45:56 PM	11/29/2017 8:45 PM
Details	Entity Subname	Update	Recertification	REGIONAL MEDICAL CLINIC - ASPEN CENTRE / PRIMARY CARE	REGIONAL HEALTH MEDICAL CLINIC FLORMANN STREET - PRIMARY CARE	11/29/2017 8:45 PM
Details	Entity Name	Update	Recertification	RAPID CITY REGIONAL HOSPITAL	Regional Health Rapid City Hospital	11/29/2017 8:42 PM
Contacts	Primary Contact	Insert	Change Request		Haupt, Kami 340B Supervisor Regional Health 6057557184	10/18/2017 2:39 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	Insert			Davidson, Paulette Chief Operating Officer 6057559138	7/12/2017 6:27 PM
Contacts	Signed By	Insert			Gibbs, Michael PRESIDENT 6057558162	7/12/2017 1:59 PM
Addresses	Main Address	Insert			640 FLORMANN ST RAPID CITY, SD 57701	7/12/2017 1:59 PM
Details	Last Recertification Date	Update			8/10/2016 12:00:00 AM	8/10/2016 11:01 AM
Dates	Participating Approval Date	Update			10/28/2015 12:00:00 AM	10/28/2015 11:08 AM
Details	State	Update		Pending	Active	10/28/2015 11:08 AM
Dates	Start Date	Update			1/1/2016 12:00:00 AM	10/28/2015 11:08 AM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG_54881	DSH430077N	10/13/2015 1:41 PM
Details	340B ID	Update			OUTPATIENT_ONLINE_REG_54881	10/9/2015 11:56 AM
Details	Last Recertification Date	Insert				10/9/2015 11:56 AM
Details	Grant Number	Insert				10/9/2015 11:56 AM
Details	340B ID	Insert				10/9/2015 11:56 AM
Details	Is Authorizing Official EHB Data	Insert				10/9/2015 11:56 AM
Dates	Last Date That 340B Drugs Purchased	Insert				10/9/2015 11:56 AM
Details	Medicare Provider Number	Insert			430077	10/9/2015 11:56 AM
Details	Entity Name	Insert			RAPID CITY REGIONAL HOSPITAL	10/9/2015 11:56 AM
Details	Program Code	Insert			DSH	10/9/2015 11:56 AM
Details	Entity Subname	Insert			REGIONAL MEDICAL CLINIC - ASPEN CENTRE / PRIMARY CARE	10/9/2015 11:56 AM
Dates	Participating Approval Date	Insert				10/9/2015 11:56 AM
Details	State	Insert			Pending	10/9/2015 11:56 AM
Dates	Registration Date	Insert			10/9/2015 12:00:00 AM	10/9/2015 11:56 AM
Dates	Signed By Date	Insert			10/9/2015 12:00:00 AM	10/9/2015 11:56 AM
Dates	Start Date	Insert				10/9/2015 11:56 AM
Terminations	Termination Comments	Insert				10/9/2015 11:56 AM
Terminations	Termination Date	Insert				10/9/2015 11:56 AM
Terminations	Termination Effective Date	Insert				10/9/2015 11:56 AM
Terminations	Termination Reason	Insert				10/9/2015 11:56 AM