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DSH430048 SPEARFISH REGIONAL HOSPITAL (Terminated)
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Main Details
Name
SPEARFISH REGIONAL HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH430048
Medicare Provider Number
430048
Additional Details
Current Program Status
Terminated
Registration Date
1/11/2019
Participating Start Date
4/1/2019
Participating Approval Date
1/20/2019
Last Recertification Date
8/22/2019
Termination Date
Termination Reason
3/31/2020
Change of covered entity type (non-hospital)
Contacts
Authorizing Official
Regional Health Spearifsh Hospital
Thomas Worsley, President
(605) 644-4091
Primary Contact
Regional Health
Kami Haupt, 340B Supervisor
(605) 755-7184
Addresses
Street Address
1440 NORTH MAIN
SPEARFISH, SD 57783
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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