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B & L INC
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
B & L INC
Pharmacy Address
BOYDS DRUG MART
909 E SAINT PATRICK ST
RAPID CITY, SD 57701
Pharmacy Comments
Contract Details
Approval Date
1/24/2012
Contract Begin Date
1/24/2012
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Timothy Sughrue, CEO
(605) 719-1000
Contract Pharmacy Representative
Scott Vincent, Operations/Treasurer
(605) 718-4040
Signed By Date
12/22/2011
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