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MONUMENT HEALTH HOME PLUS PHARMACY
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
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
Contract Termination Date
Termination Reason
4/1/2019
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Larry Walter Veitz, CEO
(605) 644-4000 Ext: 4091
Contract Pharmacy Representative
Regional Health Home Plust
SCOTT PETERSON, DIRECTOR
(605) 755-7141
Signed By Date
1/17/2017
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