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MONUMENT HEALTH HOME PLUS PHARMACY
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
MONUMENT HEALTH HOME PLUS PHARMACY
Pharmacy Address
353 FAIRMONT BLVD
RAPID CITY, SD 57701
Pharmacy Comments
Contract Details
Approval Date
1/17/2017
Contract Begin Date
1/18/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
VERONICA SCHMIDT, President
(605) 673-9415
Contract Pharmacy Representative
Regional Health Home Plust
SCOTT PETERSON, DIRECTOR
(605) 755-7141
Signed By Date
1/17/2017
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