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MONUMENT HEALTH HOME PLUS PHARMACY
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
MONUMENT HEALTH HOME PLUS PHARMACY
Pharmacy Address
353 FAIRMONT BLVD
RAPID CITY, SD 57701
Pharmacy Comments
Contract Details
Approval Date
1/18/2017
Contract Begin Date
1/18/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Dennis Millirons, PRESIDENT
(605) 755-8703
Contract Pharmacy Representative
Regional Health Home Plust
SCOTT PETERSON, DIRECTOR
(605) 755-7141
Signed By Date
1/18/2017
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