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SCH430048-12 MONUMENT HEALTH SPEARFISH HOSPITAL (Terminated)
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Main Details
Name
MONUMENT HEALTH SPEARFISH HOSPITAL
Subdivision Name
MONUMENT HEALTH BELLE FOURCHE CLINIC
Type
Sole Community Hospital
Rural
Yes
340B ID
SCH430048-12
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
3/9/2020
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
2200 13th Ave
Belle Fourche, SD 57717
Billing Address
Monument Health Spearfish Hospital
1440 North Main
Spearfish, SD 57783
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participating start date 4/1/2016; Terminated 4/1/2019; Reinstated 4/1/2020.
02/26/2020
April 2025
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