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REGIONAL HEALTH HOME PLUS LONG TERM CARE
CAH431323-00 MONUMENT HEALTH CUSTER HOSPITAL
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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
REGIONAL HEALTH HOME PLUS LONG TERM CARE
Pharmacy Address
REGIONAL HEALTH HOME PLUS LLC
1906 LOMBARDY DR STE 101
RAPID CITY, SD 57703-4132
Pharmacy Comments
Contract Details
Approval Date
2/28/2013
Contract Begin Date
4/1/2013
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/15/2019
Pharmacy closed
Contacts
Covered Entity Signing Official
VERONICA SCHMIDT, President
(605) 673-9415
Contract Pharmacy Representative
Timothy Sughrue, CEO
(605) 719-1000
Signed By Date
1/15/2013
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