Covered Entity Details

CHC29012-04 Marias Healthcare Services Inc (Active) - information as of 5/13/2025 10:56:12 PM

Main Details

Name

Marias Healthcare Services Inc

Subdivision Name

Marias Healthcare Services - Conrad

Type

HRSA-Funded Health Center

Site ID

BPS-H80-022110

340B ID

CHC29012-04

Grant Number

H80CS29012

Additional Details

Current Program Status

Active

Registration Date

8/27/2018

Participating Start Date

10/1/2018

Participating Approval Date

8/27/2018

Last Recertification Date

2/10/2025

Contacts

Authorizing Official

Marias Healthcare Services Inc
Jamie F Brownell, CEO
(406) 434-3110

Primary Contact

Marias Healthcare Services Inc
Dan Leck, COO
(406) 434-3106

Addresses

Street Address

1 4th Ave SE
Conrad, MT 59425-2323

Billing Address
Same as Street Address

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	1790275709,1881697209	1790275709

Shipping Addresses

Same as Street Address

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Termination Date	Last Updated On
Contract Detail	CHESTER PHARMACY INC	ATTN: KURT ROBERT MATKIN, PERSON IN CHAR	30 MAIN ST	CHESTER	MT	59522-7816	04/01/2019	07/01/2019		07/01/2019
Contract Detail	NORTHTOWN DRUG	ANN CLARK	100 MAIN ST PO BOX 917	SHELBY	MT	59474-1906	04/01/2019	07/01/2019		07/01/2019
Contract Detail	OLSONS DRUG		5 4TH AVE S.E.	CONRAD	MT	59425	04/01/2019	07/01/2019		07/01/2019
Contract Detail	VILLAGE DRUG	600 S MAIN ST		CONRAD	MT	59425	04/01/2019	07/01/2019		07/01/2019
Contract Detail	WALGREEN CO	DBA: WALGREENS #10859	1213 3RD ST NW	GREAT FALLS	MT	59404-4116	04/01/2019	07/01/2019	04/15/2020	04/16/2020
Contract Detail	WALGREENS MAIL SERVICE, LLC	WALGREENS MAIL SERVICE #03397	8350 S RIVER PARKWAY	TEMPE	AZ	85284	04/01/2019	07/01/2019	04/15/2020	04/16/2020
Contract Detail	WALGREENS.COM, INC.	DBA: WALGREENS	2225 S. PRICE ROAD	CHANDLER	AZ	85286	04/01/2019	07/01/2019	04/15/2020	04/16/2020

Grantee Sites

340B ID	340B Status	SiteId	Name	Sub Name	Address	City	State
CHC29012-00	Active	BPS-H80-033747	MARIAS HEALTHCARE SERVICES INC	Marias Healthcare Services Inc - Shelby	1950 W Roosevelt Hwy	SHELBY	MT
CHC29012-01	Active	BPS-H80-015584	MARIAS HEALTHCARE SERVICES INC	Marias Healthcare Services - Sunburst	13 1st St South	Sunburst	MT
CHC29012-02	Active	BPS-H80-015604	MARIAS HEALTHCARE SERVICES INC	Marias Healthcare Services - Valier	422 Montana	Valier	MT
CHC29012-03	Active	BPS-H80-015586	MARIAS HEALTHCARE SERVICES INC	Marias Healthcare Services - Dentistry	865 OILFIELD AVE	SHELBY	MT
CHC29012-04	Active	BPS-H80-022110	Marias Healthcare Services Inc	Marias Healthcare Services - Conrad	1 4th Ave SE	Conrad	MT

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CHC29012-00	CHESTER PHARMACY INC	ATTN: KURT ROBERT MATKIN, PERSON IN CHAR	30 MAIN ST	CHESTER	MT	59522-7816	07/01/2019
CHC29012-01	CHESTER PHARMACY INC	ATTN: KURT ROBERT MATKIN, PERSON IN CHAR	30 MAIN ST	CHESTER	MT	59522-7816	07/01/2019
CHC29012-02	CHESTER PHARMACY INC	ATTN: KURT ROBERT MATKIN, PERSON IN CHAR	30 MAIN ST	CHESTER	MT	59522-7816	07/01/2019
CHC29012-03	CHESTER PHARMACY INC	ATTN: KURT ROBERT MATKIN, PERSON IN CHAR	30 MAIN ST	CHESTER	MT	59522-7816	07/01/2019
CHC29012-04	CHESTER PHARMACY INC	ATTN: KURT ROBERT MATKIN, PERSON IN CHAR	30 MAIN ST	CHESTER	MT	59522-7816	07/01/2019
CHC29012-00	NORTHTOWN DRUG	ANN CLARK	100 MAIN ST PO BOX 917	SHELBY	MT	59474-1906	01/01/2016
CHC29012-02	NORTHTOWN DRUG	ANN CLARK	100 MAIN ST PO BOX 917	SHELBY	MT	59474-1906	01/01/2016
CHC29012-01	NORTHTOWN DRUG	ANN CLARK	100 MAIN ST PO BOX 917	SHELBY	MT	59474-1906	01/01/2016
CHC29012-03	NORTHTOWN DRUG	ANN CLARK	100 MAIN ST PO BOX 917	SHELBY	MT	59474-1906	01/01/2016
CHC29012-04	NORTHTOWN DRUG	ANN CLARK	100 MAIN ST PO BOX 917	SHELBY	MT	59474-1906	07/01/2019
CHC29012-00	OLSONS DRUG		5 4TH AVE S.E.	CONRAD	MT	59425	07/01/2019
CHC29012-01	OLSONS DRUG		5 4TH AVE S.E.	CONRAD	MT	59425	07/01/2019
CHC29012-02	OLSONS DRUG		5 4TH AVE S.E.	CONRAD	MT	59425	07/01/2019
CHC29012-03	OLSONS DRUG		5 4TH AVE S.E.	CONRAD	MT	59425	07/01/2019
CHC29012-04	OLSONS DRUG		5 4TH AVE S.E.	CONRAD	MT	59425	07/01/2019
CHC29012-00	SHOPKO PHARMACY #2766	1950 W ROOSEVELT HWY		SHELBY	MT	59474	10/01/2016	02/28/2019
CHC29012-02	SHOPKO PHARMACY #2766	1950 W ROOSEVELT HWY		SHELBY	MT	59474	10/01/2016	02/28/2019
CHC29012-01	SHOPKO PHARMACY #2766	1950 W ROOSEVELT HWY		SHELBY	MT	59474	10/01/2016	02/28/2019
CHC29012-03	SHOPKO PHARMACY #2766	1950 W ROOSEVELT HWY		SHELBY	MT	59474	10/01/2016	02/28/2019
CHC29012-00	VILLAGE DRUG	600 S MAIN ST		CONRAD	MT	59425	07/01/2019
CHC29012-01	VILLAGE DRUG	600 S MAIN ST		CONRAD	MT	59425	07/01/2019
CHC29012-02	VILLAGE DRUG	600 S MAIN ST		CONRAD	MT	59425	07/01/2019
CHC29012-03	VILLAGE DRUG	600 S MAIN ST		CONRAD	MT	59425	07/01/2019
CHC29012-04	VILLAGE DRUG	600 S MAIN ST		CONRAD	MT	59425	07/01/2019
CHC29012-00	WALGREEN CO	DBA: WALGREENS #10859	1213 3RD ST NW	GREAT FALLS	MT	59404-4116	07/01/2019	04/15/2020
CHC29012-01	WALGREEN CO	DBA: WALGREENS #10859	1213 3RD ST NW	GREAT FALLS	MT	59404-4116	07/01/2019	04/15/2020
CHC29012-02	WALGREEN CO	DBA: WALGREENS #10859	1213 3RD ST NW	GREAT FALLS	MT	59404-4116	07/01/2019	04/15/2020
CHC29012-03	WALGREEN CO	DBA: WALGREENS #10859	1213 3RD ST NW	GREAT FALLS	MT	59404-4116	07/01/2019	04/15/2020
CHC29012-04	WALGREEN CO	DBA: WALGREENS #10859	1213 3RD ST NW	GREAT FALLS	MT	59404-4116	07/01/2019	04/15/2020
CHC29012-00	WALGREENS MAIL SERVICE, LLC	WALGREENS MAIL SERVICE #03397	8350 S RIVER PARKWAY	TEMPE	AZ	85284	07/01/2019	04/15/2020
CHC29012-01	WALGREENS MAIL SERVICE, LLC	WALGREENS MAIL SERVICE #03397	8350 S RIVER PARKWAY	TEMPE	AZ	85284	07/01/2019	04/15/2020
CHC29012-02	WALGREENS MAIL SERVICE, LLC	WALGREENS MAIL SERVICE #03397	8350 S RIVER PARKWAY	TEMPE	AZ	85284	07/01/2019	04/15/2020
CHC29012-03	WALGREENS MAIL SERVICE, LLC	WALGREENS MAIL SERVICE #03397	8350 S RIVER PARKWAY	TEMPE	AZ	85284	07/01/2019	04/15/2020
CHC29012-04	WALGREENS MAIL SERVICE, LLC	WALGREENS MAIL SERVICE #03397	8350 S RIVER PARKWAY	TEMPE	AZ	85284	07/01/2019	04/15/2020
CHC29012-00	WALGREENS.COM, INC.	DBA: WALGREENS	2225 S. PRICE ROAD	CHANDLER	AZ	85286	07/01/2019	04/15/2020
CHC29012-01	WALGREENS.COM, INC.	DBA: WALGREENS	2225 S. PRICE ROAD	CHANDLER	AZ	85286	07/01/2019	04/15/2020
CHC29012-02	WALGREENS.COM, INC.	DBA: WALGREENS	2225 S. PRICE ROAD	CHANDLER	AZ	85286	07/01/2019	04/15/2020
CHC29012-03	WALGREENS.COM, INC.	DBA: WALGREENS	2225 S. PRICE ROAD	CHANDLER	AZ	85286	07/01/2019	04/15/2020
CHC29012-04	WALGREENS.COM, INC.	DBA: WALGREENS	2225 S. PRICE ROAD	CHANDLER	AZ	85286	07/01/2019	04/15/2020

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	1/30/2024 1:04:34 PM	2/10/2025 9:31:46 AM	2/10/2025 9:31 AM
Details	Last Recertification Date	Update	Recertification	1/30/2023 9:31:08 AM	1/30/2024 1:04:34 PM	1/30/2024 1:04 PM
Details	Last Recertification Date	Update	Recertification	2/2/2022 10:38:45 AM	1/30/2023 9:31:08 AM	1/30/2023 9:31 AM
Contacts	Primary Contact	Update	Change Request	Keil, Alyssa CFO Marias Healthcare Services Inc 4064343135	Leck, Dan COO Marias Healthcare Services Inc 4064343106	9/15/2022 6:38 AM
Contacts	Primary Contact	Update	Recertification	Gernaat, Alyssa F CFO Marias Healthcare Services Inc 4064343135	Keil, Alyssa CFO Marias Healthcare Services Inc 4064343135	2/2/2022 10:38 AM
Details	Last Recertification Date	Update	Recertification	2/1/2021 4:40:30 PM	2/2/2022 10:38:45 AM	2/2/2022 10:38 AM
Contacts	Authorizing Official	Update	AO Change Request	Brownell, Jamie F CEO Marias Healthcare Services 4064343110	Brownell, Jamie F CEO Marias Healthcare Services Inc 4064343110	2/2/2022 6:35 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	2/1/2021 4:40 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		1881697209	2/1/2021 4:40 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		MT	2/1/2021 4:40 PM
Medicaid Billing	NPI: State	Update	Recertification		MT	2/1/2021 4:40 PM
Details	Last Recertification Date	Update	Recertification	1/27/2020 12:57:21 PM	2/1/2021 4:40:30 PM	2/1/2021 4:40 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	1/27/2020 12:57 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		1790275709	1/27/2020 12:57 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		MT	1/27/2020 12:57 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1790275709	1/27/2020 12:57 PM
Details	Last Recertification Date	Update	Recertification	1/31/2019 6:11:23 PM	1/27/2020 12:57:21 PM	1/27/2020 12:57 PM
Details	Last Recertification Date	Update	Recertification		1/31/2019 6:11:23 PM	1/31/2019 6:11 PM
Details	State	Update		Approved	Active	10/1/2018 12:05 AM
Contacts	Signed By	Insert	New Registration		Brownell, Jamie F CEO Marias Healthcare Services 4064343110	8/27/2018 2:09 PM
Details	340B ID	Update	New Registration		CHC29012-04	8/27/2018 2:09 PM
Dates	Participating Approval Date	Update	New Registration		8/27/2018 2:09:45 PM	8/27/2018 2:09 PM
Details	State	Update	New Registration	Pending	Approved	8/27/2018 2:09 PM
Dates	Signed By Date	Update	New Registration		8/27/2018 12:52:28 PM	8/27/2018 2:09 PM
Dates	Start Date	Update	New Registration		10/1/2018 12:00:00 AM	8/27/2018 2:09 PM
Addresses	Main Address	Insert	New Registration		1 4th Ave SE Conrad, MT 59425-2323	8/27/2018 12:52 PM
Contacts	Authorizing Official	Insert	New Registration		Brownell, Jamie F CEO Marias Healthcare Services 4064343110	8/27/2018 12:52 PM
Contacts	Primary Contact	Insert	New Registration		Gernaat, Alyssa F CFO Marias Healthcare Services Inc 4064343135	8/27/2018 12:52 PM
Details	Last Recertification Date	Insert	New Registration			8/27/2018 12:52 PM
Details	Grant Number	Insert	New Registration		H80CS29012	8/27/2018 12:52 PM
Details	340B ID	Insert	New Registration			8/27/2018 12:52 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			8/27/2018 12:52 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			8/27/2018 12:52 PM
Details	Medicare Provider Number	Insert	New Registration			8/27/2018 12:52 PM
Details	Entity Name	Insert	New Registration		Marias Healthcare Services Inc	8/27/2018 12:52 PM
Details	Program Code	Insert	New Registration		CH	8/27/2018 12:52 PM
Details	Entity Subname	Insert	New Registration		Marias Healthcare Services - Conrad	8/27/2018 12:52 PM
Dates	Participating Approval Date	Insert	New Registration			8/27/2018 12:52 PM
Details	State	Insert	New Registration		Pending	8/27/2018 12:52 PM
Dates	Registration Date	Insert	New Registration		8/27/2018 12:52:26 PM	8/27/2018 12:52 PM
Dates	Signed By Date	Insert	New Registration			8/27/2018 12:52 PM
Dates	Start Date	Insert	New Registration			8/27/2018 12:52 PM
Terminations	Termination Comments	Insert	New Registration			8/27/2018 12:52 PM
Terminations	Termination Date	Insert	New Registration			8/27/2018 12:52 PM
Terminations	Termination Effective Date	Insert	New Registration			8/27/2018 12:52 PM
Terminations	Termination Reason	Insert	New Registration			8/27/2018 12:52 PM

340B Drug Pricing Program Database