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BIG SKY MANAGED CARE - GREAT FALLS
UI59401 INDIAN FAMILY HEALTH CLINIC
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Covered Entity Details
Entity Name
INDIAN FAMILY HEALTH CLINIC
Subdivision Name
Type
Urban Indian
340B ID
UI59401
Entity Address
1220 CENTRAL AVENUE
SUITE #1B
GREAT FALLS, MT 59401
Grant Number
Participating Start Date
7/1/2019
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
BIG SKY MANAGED CARE - GREAT FALLS
Pharmacy Address
915 1ST AVE S STE 110
GREAT FALLS, MT 59401-3705
Pharmacy Comments
Contract Details
Approval Date
7/18/2019
Contract Begin Date
10/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
2/5/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Wesley L Old Coyote, Chief Executive Officer
(406) 268-1587
Contract Pharmacy Representative
Big Sky Managed Care
Matthew Mills, Owner
(406) 315-1989
Signed By Date
7/18/2019
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