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Walgreens #21397
CAH431323-00 MONUMENT HEALTH CUSTER HOSPITAL
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Covered Entity Details
Entity Name
MONUMENT HEALTH CUSTER HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH431323-00
Entity Address
1220 MONTGOMERY ST
CUSTER, SD 57730
Medicare Provider Number
431323
Participating Start Date
1/1/2011
Last Recertification Date
8/29/2024
Pharmacy Details
Pharmacy Name
Walgreens #21397
Pharmacy Address
Walgreens Central Fill #21397
5675 Pecos St.
Suite 100
Denver, CO 80221-6655
Pharmacy Comments
Contract Details
Approval Date
7/15/2022
Contract Begin Date
10/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Barb Hespen, President Custer Market
(605) 717-2020
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/15/2022
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