Covered Entity Details

CH08327J BUTTE-SILVER BOW PRIMARY HEALTH CARE CLINIC, INC (Active) - information as of 4/29/2025 5:19:03 AM

Main Details

Name

BUTTE-SILVER BOW PRIMARY HEALTH CARE CLINIC, INC

Subdivision Name

Emma Park Neighborhood Center

Type

HRSA-Funded Health Center

Site ID

BPS-H80-014795

340B ID

CH08327J

Grant Number

H80CS00799

Additional Details

Current Program Status

Active

Registration Date

10/13/2015

Participating Start Date

1/1/2016

Participating Approval Date

10/23/2015

Last Recertification Date

3/3/2025

Contacts

Authorizing Official

Butte Silver Bow Primary Health Care, Inc
Michele K Davis, CFO
(406) 496-6025

Primary Contact

Butte Silver Bow Primary Health Care
Tammy Cox, Executive Director
(406) 496-6018

Addresses

Street Address

25 W Silver St
BUTTE, MT 59701

Billing Address

Butte-Silver Bow Primary Health Center Clinic, Inc.
445 Centennial Ave
Butte, MT 59701

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
History

Comments

Comment	Last Updated On
No records to display.

Medicaid Billing

At this site, will the covered entity bill Medicaid fee-for-service for drugs purchased at 340B prices?
Yes

State	Medicaid Number	NPI Number
MT	1285725143	1285725143

Shipping Addresses

Same as Street Address

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Carve-In Effective Date	Termination Date	Last Updated On
No records to display.

Grantee Sites

340B ID	340B Status	SiteId	Name	Sub Name	Address	City	State
CH083270	Active	BPS-H80-003105	BUTTE-SILVER BOW PRIMARY HEALTH CARE CLINIC, INC	BUTTE-SILVER BOW PRIMARY HEALTH CARE	445 Centennial Ave.	Butte	MT
CH08327F	Active	BPS-H80-036717	Butte-Silver Bow Primary Health Care Clinic, Inc	Blacktail Medical Clinic	125 E Glendale St	Dillon	MT
CH08327H	Terminated	BPS-H80-003482	Butte Silver Bow Primary Health Care Clinic, Inc	SHERIDAN COMMUNITY HEALTH CENTER	317 Madison St.	Sheridan	MT
CH08327J	Active	BPS-H80-014795	BUTTE-SILVER BOW PRIMARY HEALTH CARE CLINIC, INC	Emma Park Neighborhood Center	25 W Silver St	BUTTE	MT
CH08327K	Terminated	BPS-H80-006649	BUTTE-SILVER BOW PRIMARY HEALTH CARE CLINIC, INC	BUTTE RESCUE MISSION	1204 E 2nd St	Butte	MT
CH08327L	Active	BPS-H80-027341	BUTTE-SILVER BOW PRIMARY HEALTH CARE CLINIC, INC	Anaconda Community Health Center	110 Oak St	Anaconda	MT
CH08327M	Terminated	BPS-H80-027548	BUTTE-SILVER BOW PRIMARY HEALTH CARE CLINIC, INC	Western Montana Mental Health --Silver House	106 W Broadway St.	Butte	MT
CH08327N	Active	BPS-H80-028272	Butte-Silver Bow Primary Health Care Clinic, Inc.	BUTTE RESCUE MISSION	610 E Platinum St	Butte	MT
CH08327P	Active	BPS-H80-032896	Butte-Silver Bow Primary Health Care Clinic, Inc.	Kennedy Elementary Room #206	1101 N Emmett Ave	Butte	MT
CH08327Q	Active	BPS-H80-032882	Butte-Silver Bow Primary Health Care Clinic, Inc.	Blacktail Dental Clinic	122 E Glendale St	Dillon	MT
CH08327R	Active	BPS-H80-035693	Butte-Silver Bow Primary Health Care Clinic, Inc.	West Elementary	1000 Steel St	Butte	MT
CH08327S	Active	BPS-H80-039457	BUTTE-SILVER BOW PRIMARY HEALTH CARE CLINIC, INC	Butte Silver Bow Health Department Mobile Clinic	25 W Front St	Butte	MT

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CH083270	DRISCOLL DRUG	327 S EXCELSIOR AVE		BUTTE	MT	59701-1536	10/01/2014	02/06/2019
CH083270	MONTANA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 08627	1275 HARRISON ST.	BUTTE	MT	59701	10/01/2020	10/01/2020
CH083270	MONTANA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 08618	1300 E. PARK AVE.	ANACONDA	MT	59711	10/01/2020	10/01/2020
CH083270	SAFEWAY INC	SAFEWAY PHARMACY #1581	570 N MONTANA ST	DILLON	MT	59725	07/01/2014
CH083270	SAFEWAY INC	SAFEWAY PHARMACY #3279	2500 MASSACHUSETTS AVE	BUTTE	MT	59701	07/01/2014
CH08327N	SAFEWAY INC	SAFEWAY PHARMACY #3279	2500 MASSACHUSETTS AVE	BUTTE	MT	59701	01/01/2024
CH08327Q	SAFEWAY INC	SAFEWAY PHARMACY #1581	570 N MONTANA ST	DILLON	MT	59725	01/01/2024
CH083270	SHOPKO PHARMACY #2529	125 E GLENDALE ST		DILLON	MT	59725	10/01/2016	02/07/2019
CH083270	THRIFTY DRUG STORE	MICHAEL RICHARDS; PIC: KELLIE WILSON	201 E PARK AVE	ANACONDA	MT	59711	10/01/2019	10/01/2019
CH083270	VANS PHARMACY	ATTN: BONNIE R. REBISH, RPH, PHARMACIST	110 SOUTHSIDE BOULEVARD	DILLON	MT	59725	10/01/2014	04/03/2019
CH083270	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	01/01/2020
CH083270	WAL-MART PHARMACY 10-1901	3901 HARRISON AVENUE		BUTTE	MT	59701	07/01/2014
CH08327L	WAL-MART PHARMACY 10-1901	3901 HARRISON AVENUE		BUTTE	MT	59701	01/01/2024
CH083270	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	01/01/2020
CH083270	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	04/01/2023
CH083270	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	01/01/2024

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Addresses	Main Address	Update	Recertification	25 W. Silver St. BUTTE, MT 59701-9222	25 W Silver St BUTTE, MT 59701	3/3/2025 7:24 AM
Addresses	Billing Address	Update	Recertification	Butte Silver Bow Primary Health Center Clinic, INC 445 Centennial Ave. Butte, MT 59701	Butte-Silver Bow Primary Health Center Clinic, Inc. 445 Centennial Ave Butte, MT 59701	3/3/2025 7:24 AM
Details	Last Recertification Date	Update	Recertification	2/8/2024 6:59:06 PM	3/3/2025 7:24:23 AM	3/3/2025 7:24 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	2/8/2024 6:59 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		1285725143	2/8/2024 6:59 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		MT	2/8/2024 6:59 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1285725143	2/8/2024 6:59 PM
Medicaid Billing	NPI: State	Insert	Recertification		MT	2/8/2024 6:59 PM
Details	Last Recertification Date	Update	Recertification	2/22/2023 2:17:24 PM	2/8/2024 6:59:06 PM	2/8/2024 6:59 PM
Contacts	Primary Contact	Update	Profile Change Request	Cox, Tammy Pharmacy Director Butte Silver Bow Primary Health Care 4064966033	Cox, Tammy Executive Director Butte Silver Bow Primary Health Care 4064966018	2/8/2024 4:37 PM
Addresses	Billing Address	Update	Recertification	Butte Silver Bow Primary Health Center Clinic, INC 445 Centennial Butte, MT 59701	Butte Silver Bow Primary Health Center Clinic, INC 445 Centennial Ave. Butte, MT 59701	2/22/2023 2:17 PM
Details	Last Recertification Date	Update	Recertification	2/24/2022 7:08:46 PM	2/22/2023 2:17:24 PM	2/22/2023 2:17 PM
Details	Last Recertification Date	Update	Recertification	2/22/2021 9:38:57 AM	2/24/2022 7:08:46 PM	2/24/2022 7:08 PM
Details	Last Recertification Date	Update	Recertification	2/21/2020 12:22:28 PM	2/22/2021 9:38:57 AM	2/22/2021 9:38 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1285725143 ( )		7/15/2020 9:19 AM
Contacts	Authorizing Official	Update	Change Request	Malone, Jennifer Chief Executive Officer Butte-Silver Bow Primary Healthcare Clinic 4064966018	Davis, Michele K CFO Butte Silver Bow Primary Health Care, Inc 4064966025	7/15/2020 9:19 AM
Details	Last Recertification Date	Update	Recertification	2/11/2019 12:04:18 PM	2/21/2020 12:22:28 PM	2/21/2020 12:22 PM
Details	Last Recertification Date	Update	Recertification	2/12/2018 11:04:12 AM	2/11/2019 12:04:18 PM	2/11/2019 12:04 PM
Details	Last Recertification Date	Update	Recertification	2/6/2017 12:00:00 AM	2/12/2018 11:04:12 AM	2/12/2018 11:04 AM
Contacts	Authorizing Official	Insert	Change Request		Malone, Jennifer Chief Executive Officer Butte-Silver Bow Primary Healthcare Clinic 4064966018	10/5/2017 8:47 AM
Details	Is Authorizing Official EHB Data	Update	Change Request	False		10/5/2017 8:47 AM
Contacts	Primary Contact	Update		Cox, Tammy Pharmacy Director 4064966033	Cox, Tammy Pharmacy Director Butte Silver Bow Primary Health Care 4064966033	9/25/2017 3:53 PM
Contacts	Signed By	Insert			Cotton, Jessica CEO 4064966018	2/6/2017 2:24 PM
Addresses	Main Address	Insert			25 W. Silver St. BUTTE, MT 59701-9222	2/6/2017 11:16 AM
Contacts	Primary Contact	Insert			Cox, Tammy Pharmacy Director 4064966033	2/6/2017 11:16 AM
Details	Last Recertification Date	Update		2/26/2016 12:00:00 AM	2/6/2017 12:00:00 AM	2/6/2017 11:16 AM
Details	Last Recertification Date	Update			2/26/2016 12:00:00 AM	2/26/2016 10:50 AM
Dates	Participating Approval Date	Update			10/23/2015 12:00:00 AM	10/23/2015 6:22 PM
Details	State	Update		Pending	Active	10/23/2015 6:22 PM
Dates	Start Date	Update			1/1/2016 12:00:00 AM	10/23/2015 6:22 PM
Addresses	Billing Address	Insert			Butte Silver Bow Primary Health Center Clinic, INC 445 Centennial Butte, MT 59701	10/23/2015 6:22 PM
Details	340B ID	Update		ONLINE_REG_55456	CH08327J	10/16/2015 7:52 AM
Details	340B ID	Update		ONLINE_REG	ONLINE_REG_55456	10/13/2015 5:28 PM
Medicaid Billing	NPI: Number	Insert			1285725143	10/13/2015 5:28 PM
Details	Last Recertification Date	Insert				10/13/2015 5:28 PM
Details	Grant Number	Insert			H80CS00799	10/13/2015 5:28 PM
Details	340B ID	Insert			ONLINE_REG	10/13/2015 5:28 PM
Details	Is Authorizing Official EHB Data	Insert			False	10/13/2015 5:28 PM
Dates	Last Date That 340B Drugs Purchased	Insert				10/13/2015 5:28 PM
Details	Medicare Provider Number	Insert				10/13/2015 5:28 PM
Details	Entity Name	Insert			BUTTE-SILVER BOW PRIMARY HEALTH CARE CLINIC, INC	10/13/2015 5:28 PM
Details	Program Code	Insert			CH	10/13/2015 5:28 PM
Details	Entity Subname	Insert			Emma Park Neighborhood Center	10/13/2015 5:28 PM
Dates	Participating Approval Date	Insert				10/13/2015 5:28 PM
Details	State	Insert			Pending	10/13/2015 5:28 PM
Dates	Registration Date	Insert			10/13/2015 12:00:00 AM	10/13/2015 5:28 PM
Dates	Signed By Date	Insert			10/13/2015 12:00:00 AM	10/13/2015 5:28 PM
Dates	Start Date	Insert				10/13/2015 5:28 PM
Terminations	Termination Comments	Insert				10/13/2015 5:28 PM
Terminations	Termination Date	Insert				10/13/2015 5:28 PM
Terminations	Termination Effective Date	Insert				10/13/2015 5:28 PM
Terminations	Termination Reason	Insert				10/13/2015 5:28 PM

340B Drug Pricing Program Database