Contract Pharmacy Details

CARSON DRUG
DSH430077 Monument Health Rapid City Hospital

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

CARSON DRUG

Pharmacy Address

521 MOUNT RUSHMORE ROAD
CUSTER, SD 57730

Pharmacy Comments

Contract Details

Approval Date

12/30/2011

Contract Begin Date

12/30/2011

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

3/31/2018
Ownership change

Contacts

Covered Entity Signing Official

Timothy Sughrue, CEO
(605) 719-1000

Contract Pharmacy Representative

John Carson, Pharmacist
(605) 673-2225

Signed By Date

12/12/2011