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MONTANA CVS PHARMACY, L.L.C.
DSH270049 Intermountain Health St Vincent Regional Hospital
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Covered Entity Details
Entity Name
Intermountain Health St Vincent Regional Hospital
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH270049
Entity Address
1233 N. 30th Street
Billings, MT 59101
Medicare Provider Number
270049
Participating Start Date
10/1/2012
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
MONTANA CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 08623
2402 GRAND AVE.
BILLINGS, MT 59102
Pharmacy Comments
Contract Details
Approval Date
3/2/2023
Contract Begin Date
3/6/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Pam Palagi, VP Financial Services
(406) 723-2414
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
3/2/2023
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