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SCH430048-13 MONUMENT HEALTH SPEARFISH HOSPITAL (Terminated)
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Main Details
Name
MONUMENT HEALTH SPEARFISH HOSPITAL
Subdivision Name
MONUMENT HEALTH SPEARFISH CLINIC - NORTH 10TH STREET - URGENT CARE
Type
Sole Community Hospital
Rural
Yes
340B ID
SCH430048-13
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
2/28/2020
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
1420 N 10TH ST
Spearfish, SD 57783
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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