340B Drug Pricing Program Database
SHOPKO PHARMACY #2746
CAH431300-00 MADISON COMMUNITY HOSPITAL - information as of 5/13/2025 2:33:47 AM
Covered Entity Details
Entity Name
MADISON COMMUNITY HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH431300-00
Entity Address
323 SW 10th St.
MADISON, SD 57042-3200
Medicare Provider Number
431300
Participating Start Date
1/1/2017
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
SHOPKO PHARMACY #2746
Pharmacy Address
800 S WASHINGTON AVE
MADISON, SD 57042
Pharmacy Comments
Contract Details
Approval Date
7/17/2018
Contract Begin Date
10/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2018
Pharmacy closed
Contacts
Covered Entity Signing Official
Teresa Rae Mallett, CEO
(605) 256-8605
Contract Pharmacy Representative
Shopko Pharmacy
Debi Danbury, 340B Program Manager
(920) 429-7613
Signed By Date
7/17/2018
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