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SAFEWAY INC
SCH430048 MONUMENT HEALTH SPEARFISH HOSPITAL
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Covered Entity Details
Entity Name
MONUMENT HEALTH SPEARFISH HOSPITAL
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH430048
Entity Address
1440 NORTH MAIN
SPEARFISH, SD 57783
Medicare Provider Number
430048
Participating Start Date
3/15/2022
Last Recertification Date
9/1/2023
Entity Termination Date
1/1/2024
Pharmacy Details
Pharmacy Name
SAFEWAY INC
Pharmacy Address
SAFEWAY PHARMACY #0583
1606 NORTH AVE STE 2
SPEARFISH, SD 57783
Pharmacy Comments
Contract Details
Approval Date
4/26/2013
Contract Begin Date
7/1/2013
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2015
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Larry Walter Veitz, CEO
(605) 644-4000 Ext: 4091
Contract Pharmacy Representative
Safeway
Merle Jarvill, Director, Managed Care
(623) 869-4260
Signed By Date
4/26/2013
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