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SHOPKO PHARMACY #2062
DSH270012 BENEFIS HOSPITALS INC.
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Covered Entity Details
Entity Name
BENEFIS HOSPITALS INC.
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH270012
Entity Address
1101 26TH STREET SOUTH
GREAT FALLS, MT 59405
Medicare Provider Number
270012
Participating Start Date
1/1/2019
Last Recertification Date
8/21/2024
Pharmacy Details
Pharmacy Name
SHOPKO PHARMACY #2062
Pharmacy Address
301 NORTHWEST BYPASS
GREAT FALLS, MT 59404-4125
Pharmacy Comments
Contract Details
Approval Date
11/19/2018
Contract Begin Date
1/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2020
Pharmacy closed
Contacts
Covered Entity Signing Official
Terry Olinger, President
(406) 455-5477
Contract Pharmacy Representative
ShopKo
Lorie Neumann, Contracting & Compliance
(920) 429-4726
Signed By Date
10/31/2018
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