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CREDENA HEALTH PHARMACY SACRED HEART
RRC270014-00 ST PATRICK HOSPITAL
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Covered Entity Details
Entity Name
ST PATRICK HOSPITAL
Subdivision Name
Type
Rural Referral Center
340B ID
RRC270014-00
Entity Address
500 W. BROADWAY ST
MISSOULA, MT 59802
Medicare Provider Number
270014
Participating Start Date
7/1/2021
Last Recertification Date
8/25/2021
Entity Termination Date
10/1/2022
Pharmacy Details
Pharmacy Name
CREDENA HEALTH PHARMACY SACRED HEART
Pharmacy Address
101 W 8TH AVE STE 207653
SPOKANE, WA 99204-2307
Pharmacy Comments
Contract Details
Approval Date
4/7/2021
Contract Begin Date
7/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2022
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Kirk Bodlovic, Chief Operating Officer
(406) 327-1740
Contract Pharmacy Representative
Providence
Tammy Pierce, Director of Pharmacy
(503) 962-1700
Signed By Date
4/5/2021
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