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WALGREEN CO
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
WALGREEN CO
Pharmacy Address
DBA: WALGREENS #10859
1213 3RD ST NW
GREAT FALLS, MT 59404-4116
Pharmacy Comments
Contract Details
Approval Date
11/19/2018
Contract Begin Date
1/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Terry Olinger, President
(406) 455-5477
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/31/2018
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