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MONTANA CVS PHARMACY, L.L.C.
DSH270012 BENEFIS HOSPITALS INC.
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Covered Entity Details
Entity Name
BENEFIS HOSPITALS INC.
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH270012
Entity Address
1101 26TH STREET SOUTH
GREAT FALLS, MT 59405
Medicare Provider Number
270012
Participating Start Date
1/1/2019
Last Recertification Date
8/21/2024
Pharmacy Details
Pharmacy Name
MONTANA CVS PHARMACY, L.L.C.
Pharmacy Address
DBA CVS/PHARMACY # 4278
3095 N. MONTANA AVE.
HELENA, MT 59601
Pharmacy Comments
Contract Details
Approval Date
10/15/2021
Contract Begin Date
1/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Forrest Ehlinger, Chief Financial Officer
(406) 455-5479
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
10/15/2021
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