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SAFEWAY INC
DSH430077 Monument Health Rapid City Hospital
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Covered Entity Details
Entity Name
Monument Health Rapid City Hospital
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH430077
Entity Address
353 FAIRMONT BLVD
RAPID CITY, SD 57701
Medicare Provider Number
430077
Participating Start Date
4/1/2004
Last Recertification Date
9/12/2024
Pharmacy Details
Pharmacy Name
SAFEWAY INC
Pharmacy Address
SAFEWAY PHARMACY #0581
2120 MT RUSHMORE RD
RAPID CITY, SD 57701
Pharmacy Comments
Contract Details
Approval Date
1/23/2018
Contract Begin Date
4/1/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Paulette Davidson, Chief Operating Officer
(605) 755-9138
Contract Pharmacy Representative
Albertsons Companies
Chuck Hanson, Senior 340B Program Manager
(208) 395-6304
Signed By Date
1/23/2018
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