Contract Pharmacy Details

WALGREEN CO.
DSH270012 BENEFIS HOSPITALS INC.

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 SPECIALTY PHARMACY #16403
1409 11TH AVE.
SEATTLE, WA 98122

Pharmacy Comments

Contract Details

Approval Date

1/22/2019

Contract Begin Date

4/1/2019

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Forrest Ehlinger, Chief Financial Officer
(406) 455-5479

Contract Pharmacy Representative

Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663

Signed By Date

1/22/2019

340B Drug Pricing Program Database