340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
SHOPKO PHARMACY #2078
DSH430077 Monument Health Rapid City Hospital
Print
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
SHOPKO PHARMACY #2078
Pharmacy Address
1845 HAINES AVENUE
RAPID CITY, SD 57701
Pharmacy Comments
Contract Details
Approval Date
4/11/2014
Contract Begin Date
7/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
2/4/2019
Pharmacy closed
Contacts
Covered Entity Signing Official
CHARLES E. HART, PRESIDENT & CEO
(605) 719-8107
Contract Pharmacy Representative
Shopko
Tad Schilke, Director of Rx Merchandising & Marketing
(920) 429-7628
Signed By Date
4/11/2014
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session