Covered Entity Details

SCH430048-14 MONUMENT HEALTH SPEARFISH HOSPITAL (Terminated) - information as of 4/25/2025 8:33:58 PM

Main Details

Name

MONUMENT HEALTH SPEARFISH HOSPITAL

Subdivision Name

MONUMENT HEALTH SPEARFISH CLINIC - NORTH 10TH STREET - CARDIOLOGY

Type

Sole Community Hospital

Rural

Yes

340B ID

SCH430048-14

Medicare Provider Number

430048

Outpatient Facility Provider Number

Additional Details

Current Program Status

Terminated

Registration Date

2/25/2020

Participating Start Date

3/15/2022

Participating Approval Date

2/28/2020

Last Recertification Date

8/14/2023

Termination Date
Termination Reason

1/1/2024
DSH percentage below statutory minimum

Contacts

Authorizing Official

Monument Health
Thomas Worsley, President
(605) 644-4091

Primary Contact

Monument Health
Kami Haupt, 340B Supervisor
(605) 755-7184

Addresses

Street Address

1420 N 10TH ST
Spearfish, SD 57783

Billing Address

Monument Health Spearfish Hospital
1440 North Main
Spearfish, SD 57783

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 Spearfish Hospital
1440 North Main
Spearfish, SD 57783

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
SCH430048-01	Child	SCH	MONUMENT HEALTH SPEARFISH HOSPITAL	Monument Health Rehabilitation - Spearfish	2449 E. Colorado Blvd.	Spearfish	SD	Terminated
SCH430048-02	Child	SCH	MONUMENT HEALTH SPEARFISH HOSPITAL	Monument Health Rehabilitation - Belle Fourche	2200 13th Avenue	Belle Fourche	SD	Terminated
SCH430048-03	Child	SCH	MONUMENT HEALTH SPEARFISH HOSPITAL	MONUMENT HEALTH DERMATOLOGY	550 EAST COLORADO BLVD	SPEARFISH	SD	Terminated
SCH430048-04	Child	SCH	MONUMENT HEALTH SPEARFISH HOSPITAL	MONUMENT HEALTH ORTHOPEDICS AND SPORTS MEDICINE	2479 EAST COLORADO BLVD	SPEARFISH	SD	Terminated
SCH430048-05	Child	SCH	MONUMENT HEALTH SPEARFISH HOSPITAL	MONUMENT HEALTH SURGERY CENTER	1316 N. 10TH ST	SPEARFISH	SD	Terminated
SCH430048-06	Child	SCH	MONUMENT HEALTH SPEARFISH HOSPITAL	MONUMENT HEALTH SPEARFISH CLINIC - NORTH 10TH STREET - PODIATRY	1420 N 10TH ST	SPEARFISH	SD	Terminated
SCH430048-07	Child	SCH	MONUMENT HEALTH SPEARFISH HOSPITAL	MONUMENT HEALTH SPEARFISH CLINIC - NORTH 10TH STREET - PRIMARY CARE	1420 N 10TH ST	SPEARFISH	SD	Terminated
SCH430048-08	Child	SCH	MONUMENT HEALTH SPEARFISH HOSPITAL	MONUMENT HEALTH SPEARFISH CLINIC - NORTH AVENUE - ENT	1445 NORTH AVE	SPEARFISH	SD	Terminated
SCH430048-09	Child	SCH	MONUMENT HEALTH SPEARFISH HOSPITAL	MONUMENT HEALTH SPEARFISH CLINIC - NORTH AVENUE - SURGERY	1445 NORTH AVE	SPEARFISH	SD	Terminated
SCH430048-10	Child	SCH	MONUMENT HEALTH SPEARFISH HOSPITAL	MONUMENT HEALTH SPEARFISH CLINIC - NORTH AVENUE - OB/GYN	1445 NORTH AVE	SPEARFISH	SD	Terminated
SCH430048-11	Child	SCH	MONUMENT HEALTH SPEARFISH HOSPITAL	MONUMENT HEALTH SPEARFISH CLINIC - NORTH AVENUE - PRIMARY CARE	1445 NORTH AVE	SPEARFISH	SD	Terminated
SCH430048-12	Child	SCH	MONUMENT HEALTH SPEARFISH HOSPITAL	MONUMENT HEALTH BELLE FOURCHE CLINIC	2200 13th Ave	Belle Fourche	SD	Terminated
SCH430048-13	Child	SCH	MONUMENT HEALTH SPEARFISH HOSPITAL	MONUMENT HEALTH SPEARFISH CLINIC - NORTH 10TH STREET - URGENT CARE	1420 N 10TH ST	Spearfish	SD	Terminated
SCH430048-14	Child	SCH	MONUMENT HEALTH SPEARFISH HOSPITAL	MONUMENT HEALTH SPEARFISH CLINIC - NORTH 10TH STREET - CARDIOLOGY	1420 N 10TH ST	Spearfish	SD	Terminated

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	State	Update		To Be Terminated	Terminated	1/1/2024 12:01 AM
Dates	Last Date That 340B Drugs Purchased	Update	Termination Request		11/29/2023 12:00:00 AM	12/1/2023 7:26 AM
Details	State	Update	Termination Request	Active	To Be Terminated	12/1/2023 7:26 AM
Terminations	Termination Date	Update	Termination Request		1/1/2024 12:00:00 AM	12/1/2023 7:26 AM
Terminations	Termination Effective Date	Update	Termination Request		11/29/2023 12:00:00 AM	12/1/2023 7:26 AM
Terminations	Termination Reason	Update	Termination Request		DSH percentage below statutory minimum	12/1/2023 7:26 AM
Details	Last Recertification Date	Update	Recertification	8/29/2022 3:34:56 PM	8/14/2023 2:25:20 PM	8/14/2023 2:25 PM
Details	Last Recertification Date	Update	Recertification	8/17/2021 1:59:49 PM	8/29/2022 3:34:56 PM	8/29/2022 3:34 PM
Dates	Last Date That 340B Drugs Purchased	Update	COVID-19 Reinstatement	1/28/2022 12:00:00 AM		4/7/2022 5:14 PM
Details	State	Update	COVID-19 Reinstatement	Terminated	Active	4/7/2022 5:14 PM
Dates	Start Date	Update	COVID-19 Reinstatement	4/1/2020 12:00:00 AM	3/15/2022 12:00:00 AM	4/7/2022 5:14 PM
Terminations	Termination Comments	Update	COVID-19 Reinstatement	Due to payer mix changes from the public health emergency, our DSH % has dropped below the 8% threshold.		4/7/2022 5:14 PM
Terminations	Termination Date	Update	COVID-19 Reinstatement	4/1/2022 12:00:00 AM		4/7/2022 5:14 PM
Terminations	Termination Effective Date	Update	COVID-19 Reinstatement	1/28/2022 12:00:00 AM		4/7/2022 5:14 PM
Terminations	Termination Reason	Update	COVID-19 Reinstatement	DSH percentage below statutory minimum		4/7/2022 5:14 PM
Details	State	Update		To Be Terminated	Terminated	4/1/2022 12:01 AM
Dates	Last Date That 340B Drugs Purchased	Update	Termination Request		1/28/2022 12:00:00 AM	2/1/2022 4:46 PM
Details	State	Update	Termination Request	Active	To Be Terminated	2/1/2022 4:46 PM
Terminations	Termination Comments	Update	Termination Request		Due to payer mix changes from the public health emergency, our DSH % has dropped below the 8% threshold.	2/1/2022 4:46 PM
Terminations	Termination Date	Update	Termination Request		4/1/2022 12:00:00 AM	2/1/2022 4:46 PM
Terminations	Termination Effective Date	Update	Termination Request		1/28/2022 12:00:00 AM	2/1/2022 4:46 PM
Terminations	Termination Reason	Update	Termination Request		DSH percentage below statutory minimum	2/1/2022 4:46 PM
Details	Last Recertification Date	Update	Recertification	8/19/2020 10:51:26 AM	8/17/2021 1:59:49 PM	8/17/2021 1:59 PM
Details	Last Recertification Date	Update	Recertification		8/19/2020 10:51:26 AM	8/19/2020 10:51 AM
Addresses	Shipping Address	Delete	Change Request	Regional Health Spearfish Hospital 1440 North Main Spearfish, SD 57783		8/14/2020 12:21 PM
Addresses	Billing Address	Update	Change Request	Regional Health Spearfish Hospital 1440 North Main Spearfish, SD 57783	Monument Health Spearfish Hospital 1440 North Main Spearfish, SD 57783	8/14/2020 12:21 PM
Addresses	Shipping Address	Insert	Change Request		Monument Health Spearfish Hospital 1440 North Main Spearfish, SD 57783	8/14/2020 12:21 PM
Contacts	Primary Contact	Update	Change Request	Haupt, Kami 340B Supervisor Regional Health 6057557184	Haupt, Kami 340B Supervisor Monument Health 6057557184	8/14/2020 12:21 PM
Details	Entity Subname	Update	Change Request	REGIONAL HEALTH MEDICAL CLINIC NORTH 10TH STREET - Cardiology - Cardiology	MONUMENT HEALTH SPEARFISH CLINIC - NORTH 10TH STREET - CARDIOLOGY	8/14/2020 12:21 PM
Contacts	Authorizing Official	Update	Change Request	Worsley, Thomas President Regional Health Spearifsh Hospital 6056444091	Worsley, Thomas President Monument Health 6056444091	7/8/2020 12:58 PM
Details	Entity Name	Update	Change Request	SPEARFISH REGIONAL HOSPITAL	MONUMENT HEALTH SPEARFISH HOSPITAL	7/8/2020 12:58 PM
Details	State	Update		Approved	Active	4/1/2020 12:05 AM
Contacts	Signed By	Insert	New Registration		Worsley, Thomas President Regional Health Spearifsh Hospital 6056444091	2/28/2020 9:03 AM
Details	340B ID	Update	New Registration		SCH430048-14	2/28/2020 9:03 AM
Details	Entity Subname	Update	New Registration	REGIONAL HEALTH MEDICAL CLINIC NORTH 10TH STREET - Cardiology	REGIONAL HEALTH MEDICAL CLINIC NORTH 10TH STREET - Cardiology - Cardiology	2/28/2020 9:03 AM
Dates	Participating Approval Date	Update	New Registration		2/28/2020 9:03:31 AM	2/28/2020 9:03 AM
Details	State	Update	New Registration	Pending	Approved	2/28/2020 9:03 AM
Dates	Signed By Date	Update	New Registration		2/25/2020 6:36:51 PM	2/28/2020 9:03 AM
Dates	Start Date	Update	New Registration		4/1/2020 12:00:00 AM	2/28/2020 9:03 AM
Addresses	Main Address	Insert	New Registration		1420 N 10TH ST Spearfish, SD 57783	2/25/2020 5:34 PM
Addresses	Billing Address	Insert	New Registration		Regional Health Spearfish Hospital 1440 North Main Spearfish, SD 57783	2/25/2020 5:34 PM
Addresses	Shipping Address	Insert	New Registration		Regional Health Spearfish Hospital 1440 North Main Spearfish, SD 57783	2/25/2020 5:34 PM
Contacts	Primary Contact	Insert	New Registration		Haupt, Kami 340B Supervisor Regional Health 6057557184	2/25/2020 5:34 PM
Contacts	Authorizing Official	Insert	New Registration		Worsley, Thomas President Regional Health Spearifsh Hospital 6056444091	2/25/2020 5:34 PM
Details	Last Recertification Date	Insert	New Registration			2/25/2020 5:34 PM
Details	Grant Number	Insert	New Registration			2/25/2020 5:34 PM
Details	340B ID	Insert	New Registration			2/25/2020 5:34 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			2/25/2020 5:34 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			2/25/2020 5:34 PM
Details	Medicare Provider Number	Insert	New Registration		430048	2/25/2020 5:34 PM
Details	Entity Name	Insert	New Registration		SPEARFISH REGIONAL HOSPITAL	2/25/2020 5:34 PM
Details	Program Code	Insert	New Registration		SCH	2/25/2020 5:34 PM
Details	Entity Subname	Insert	New Registration		REGIONAL HEALTH MEDICAL CLINIC NORTH 10TH STREET - Cardiology	2/25/2020 5:34 PM
Dates	Participating Approval Date	Insert	New Registration			2/25/2020 5:34 PM
Details	State	Insert	New Registration		Pending	2/25/2020 5:34 PM
Dates	Registration Date	Insert	New Registration		2/25/2020 5:34:58 PM	2/25/2020 5:34 PM
Dates	Signed By Date	Insert	New Registration			2/25/2020 5:34 PM
Dates	Start Date	Insert	New Registration			2/25/2020 5:34 PM
Terminations	Termination Comments	Insert	New Registration			2/25/2020 5:34 PM
Terminations	Termination Date	Insert	New Registration			2/25/2020 5:34 PM
Terminations	Termination Effective Date	Insert	New Registration			2/25/2020 5:34 PM
Terminations	Termination Reason	Insert	New Registration			2/25/2020 5:34 PM