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POWELL DRUG
CAH531309-00 North Big Horn Hospital District
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Covered Entity Details
Entity Name
North Big Horn Hospital District
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH531309-00
Entity Address
1115 Lane 12
Lovell, WY 82431
Medicare Provider Number
531309
Participating Start Date
10/1/2011
Last Recertification Date
8/31/2024
Pharmacy Details
Pharmacy Name
POWELL DRUG
Pharmacy Address
140 N BENT ST
POWELL, WY 82435
Pharmacy Comments
Contract Details
Approval Date
10/15/2018
Contract Begin Date
1/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Rick Schroeder, CEO
(307) 548-5203
Contract Pharmacy Representative
PHARMACISTS IMPROVING LIVES, INC. DBA Powell Drug
David W. Klingler, Owner
(307) 754-2031
Signed By Date
10/15/2018
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