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WALGREEN CO
CHC29012-02 MARIAS HEALTHCARE SERVICES INC
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Covered Entity Details
Entity Name
MARIAS HEALTHCARE SERVICES INC
Subdivision Name
Marias Healthcare Services - Valier
Type
HRSA-Funded Health Center
340B ID
CHC29012-02
Entity Address
422 Montana
Valier, MT 59486-0554
Grant Number
H80CS29012
Participating Start Date
1/1/2016
Last Recertification Date
2/10/2025
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
4/1/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/15/2020
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Jamie F Brownell, CEO
(406) 434-3110
Contract Pharmacy Representative
Walgreen Co
Bradley Hedstrom, Account Manager Health Systems
(224) 515-6021
Signed By Date
4/1/2019
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