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BIGFORK DRUG INC.
SCH270051-00 KALISPELL REGIONAL MEDICAL CENTER
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Covered Entity Details
Entity Name
KALISPELL REGIONAL MEDICAL CENTER
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH270051-00
Entity Address
310 SUNNYVIEW LANE
KALISPELL, MT 59901
Medicare Provider Number
270051
Participating Start Date
9/24/2010
Last Recertification Date
9/11/2020
Entity Termination Date
1/1/2021
Pharmacy Details
Pharmacy Name
BIGFORK DRUG INC.
Pharmacy Address
8111 MT HIGHWAY 35
BIGFORK, MT 59911-3588
Pharmacy Comments
Contract Details
Approval Date
1/8/2020
Contract Begin Date
4/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2021
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Deborah M Wilson, Chief Operating Officer
(406) 752-1724
Contract Pharmacy Representative
Bigfork Drug
Stephanie D Mills, Owner/Presidnt
(406) 837-4370
Signed By Date
1/8/2020
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