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WALGREENS SPECIALTY PHARMACY, LLC
DSH430077 Monument Health Rapid City Hospital
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Covered Entity Details
Entity Name
Monument Health Rapid City Hospital
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH430077
Entity Address
353 FAIRMONT BLVD
RAPID CITY, SD 57701
Medicare Provider Number
430077
Participating Start Date
4/1/2004
Last Recertification Date
9/12/2024
Pharmacy Details
Pharmacy Name
WALGREENS SPECIALTY PHARMACY, LLC
Pharmacy Address
DBA WALGREENS SPECIALTY PHARMACY #15438
41460 HAGGERTY CIR S
CANTON, MI 48188
Pharmacy Comments
Contract Details
Approval Date
1/8/2020
Contract Begin Date
4/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Paulette Davidson, Chief Operating Officer
(605) 755-9138
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
1/8/2020
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