340B Drug Pricing Program Database
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DSH270049AA Intermountain Health St Vincent Regional Hospital (Active)
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Main Details
Name
Intermountain Health St Vincent Regional Hospital
Subdivision Name
Coumadin Clinic - Ambulatory Clinical Services
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH270049AA
Medicare Provider Number
270049
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
10/7/2024
Participating Start Date
1/1/2025
Participating Approval Date
10/23/2024
Last Recertification Date
Contacts
Authorizing Official
SCL Health Montana Region
Pam Palagi, VP Financial Services
(406) 723-2414
Primary Contact
Intermountain Health
Ben Landry, 340B Pharmacist
(207) 200-5264
Addresses
Street Address
2900 12th Ave N, Suite 209W
Billings, MT 59101
Billing Address
Intermountain Health St Vincent Regional Hospital
PO BOX 1010
LAFAYETTE, CO 80026
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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