Contract Pharmacy Details

CARSON DRUG
CAH431323-00 MONUMENT HEALTH CUSTER HOSPITAL

Covered Entity Details

Entity Name

MONUMENT HEALTH CUSTER HOSPITAL

Subdivision Name

Type

Critical Access Hospital

340B ID

CAH431323-00

Entity Address

1220 MONTGOMERY ST
CUSTER, SD 57730

Medicare Provider Number

431323

Participating Start Date

1/1/2011

Last Recertification Date

8/29/2024

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

3/30/2018
Ownership change

Contacts

Covered Entity Signing Official

VERONICA SCHMIDT, President
(605) 673-9415

Contract Pharmacy Representative

John Carson, Pharmacist
(605) 673-2225

Signed By Date

12/12/2011