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INTERMOUNTAIN PHARMACY #11
DSH270017 St. James Healthcare dba Intermountain Health St. James Hospital
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Covered Entity Details
Entity Name
St. James Healthcare dba Intermountain Health St. James Hospital
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH270017
Entity Address
400 SOUTH CLARK STREET
BUTTE, MT 59701
Medicare Provider Number
270017
Participating Start Date
4/1/2023
Last Recertification Date
8/19/2024
Entity Termination Date
7/1/2025
Pharmacy Details
Pharmacy Name
INTERMOUNTAIN PHARMACY #11
Pharmacy Address
SCL HEALTH PHARMACY SERVICES
435 S CRYSTAL ST STE 230
BUTTE, MT 59701
Pharmacy Comments
Contract Details
Approval Date
1/10/2023
Contract Begin Date
4/1/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2025
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Pam Palagi, VP Financial Services
(406) 723-2414
Contract Pharmacy Representative
SCL Health Pharmacy Services
Rhiannon Longmore, Pharmacy Business Operations Manager
(303) 272-0922
Signed By Date
1/6/2023
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