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MONUMENT HEALTH HOME PLUS HOME INFUSION
SCH430048 MONUMENT HEALTH SPEARFISH HOSPITAL
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Covered Entity Details
Entity Name
MONUMENT HEALTH SPEARFISH HOSPITAL
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH430048
Entity Address
1440 NORTH MAIN
SPEARFISH, SD 57783
Medicare Provider Number
430048
Participating Start Date
3/15/2022
Last Recertification Date
9/1/2023
Entity Termination Date
1/1/2024
Pharmacy Details
Pharmacy Name
MONUMENT HEALTH HOME PLUS HOME INFUSION
Pharmacy Address
MONUMENT HEALTH HOME PLUS LLC
224 ELK ST STE 100
RAPID CITY, SD 57701-7359
Pharmacy Comments
Contract Details
Approval Date
2/25/2020
Contract Begin Date
3/15/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2024
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Thomas Worsley, President
(605) 644-4091
Contract Pharmacy Representative
Monument Health Home Plus
Brandi Tackett, Director Clinical Innovations
(605) 755-0202
Signed By Date
2/25/2020
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