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DSH430077AE Monument Health Rapid City Hospital (Active)
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Main Details
Name
Monument Health Rapid City Hospital
Subdivision Name
MONUMENT HEALTH RAPID CITY HOSPITAL - WEIGHT MANAGEMENT
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH430077AE
Medicare Provider Number
430077
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
7/2/2019
Participating Start Date
10/1/2019
Participating Approval Date
8/2/2019
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
640 Flormann St.
RAPID CITY, SD 57701
Billing Address
Monument Health Rapid City Hospital
353 Fairmont Blvd.
Rapid City, SD 57701
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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