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LUMICERA HEALTH SERVICES, LLC
SCH270003-00 ST. PETERS HEALTH
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Covered Entity Details
Entity Name
ST. PETERS HEALTH
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH270003-00
Entity Address
2475 E Broadway St.
HELENA, MT 59601
Medicare Provider Number
270003
Participating Start Date
3/15/2022
Last Recertification Date
8/23/2024
Pharmacy Details
Pharmacy Name
LUMICERA HEALTH SERVICES, LLC
Pharmacy Address
9185 E PIMA CENTER PKWY STE 200
SCOTTSDALE, AZ 85258
Pharmacy Comments
Contract Details
Approval Date
7/12/2019
Contract Begin Date
10/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2020
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Nathan M Coburn, CFO
(406) 444-2122
Contract Pharmacy Representative
Lumicera Health Services
Tony Wood, Manager, Specialty Contracts
(608) 310-1819
Signed By Date
7/12/2019
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