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SHOPKO PHARMACY #2112
CH083930 County of Lewis and Clark
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Covered Entity Details
Entity Name
County of Lewis and Clark
Subdivision Name
PureView Health Center
Type
HRSA-Funded Health Center
340B ID
CH083930
Entity Address
1930 9th Ave
Helena, MT 59601-4759
Grant Number
H80CS00515
Participating Start Date
4/1/1997
Last Recertification Date
1/28/2020
Entity Termination Date
7/1/2020
Pharmacy Details
Pharmacy Name
SHOPKO PHARMACY #2112
Pharmacy Address
3101 MONTANA AVENUE
HELENA, MT 59601
Pharmacy Comments
Contract Details
Approval Date
10/11/2018
Contract Begin Date
1/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2020
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Jill-Marie Steeley, CEO
(406) 500-2050
Contract Pharmacy Representative
Shopko Pharmacy
Debi Danbury, 340B Program Manager
(920) 429-7613
Signed By Date
10/11/2018
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