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RRC270014-00 ST PATRICK HOSPITAL (Terminated)
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Main Details
Name
ST PATRICK HOSPITAL
Subdivision Name
Type
Rural Referral Center
Rural
No
340B ID
RRC270014-00
Medicare Provider Number
270014
Additional Details
Current Program Status
Terminated
Registration Date
4/5/2021
Participating Start Date
7/1/2021
Participating Approval Date
4/7/2021
Last Recertification Date
8/25/2021
Termination Date
Termination Reason
10/1/2022
Change of covered entity type
Contacts
Authorizing Official
Providence St. Patrick Hospital
Kirk Bodlovic, Chief Operating Officer
(406) 327-1740
Primary Contact
Providence Health & Services - Montana
Kevin Warren Cady, Director of Pharmacy
(406) 329-5720
Addresses
Street Address
500 W. BROADWAY ST
MISSOULA, MT 59802
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participating from effective date: (7/1/2018) until terminated effective date: (7/1/2019), reinstatement effective date: (07/01/2021)
04/07/2021
April 2025
April 2025
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