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DSH430077H Monument Health Rapid City Hospital (Active)
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Main Details
Name
Monument Health Rapid City Hospital
Subdivision Name
MONUMENT HEALTH RAPID CITY URGENT CARE - JACKSON BOULEVARD
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH430077H
Medicare Provider Number
430077
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
10/7/2015
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
2116 JACKSON BLVD
RAPID CITY, SD 57702-3495
Billing Address
Monument Health Rapid City Hospital
353 Fairmont Blvd.
Rapid City, SD 57701
Comments
Medicaid Billing
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