340B Drug Pricing Program Database

Pharmacy Name

MONUMENT HEALTH RAPID CITY HOSPITAL

Pharmacy Address

PHARMACY DEPARTMENT
353 FAIRMONT BLVD
RAPID CITY, SD 57701

Pharmacy Comments

Approval Date

4/12/2016

Contract Begin Date

7/1/2016

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

1/17/2017
Ownership change

Covered Entity Signing Official

Michael Gibbs, PRESIDENT
(605) 755-8162

Contract Pharmacy Representative

Regional Health
Scott Peterson, Manager Ambulatory Pharmacy
(605) 755-7141

Signed By Date

4/12/2016