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VILLAGE DRUG
CHC29012-04 Marias Healthcare Services Inc
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Covered Entity Details
Entity Name
Marias Healthcare Services Inc
Subdivision Name
Marias Healthcare Services - Conrad
Type
HRSA-Funded Health Center
340B ID
CHC29012-04
Entity Address
1 4th Ave SE
Conrad, MT 59425-2323
Grant Number
H80CS29012
Participating Start Date
10/1/2018
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
VILLAGE DRUG
Pharmacy Address
600 S MAIN ST
CONRAD, MT 59425
Pharmacy Comments
Contract Details
Approval Date
4/1/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jamie F Brownell, CEO
(406) 434-3110
Contract Pharmacy Representative
Village Drug
Brandon Utterback, Owner, Pharmacist in Charge
(406) 278-3267
Signed By Date
4/1/2019
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