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CHOTEAU DRUG, INC
CAH271307-00 BENEFIS TETON MEDICAL CENTER
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Covered Entity Details
Entity Name
BENEFIS TETON MEDICAL CENTER
Subdivision Name
Benefis Teton Medical Center
Type
Critical Access Hospital
340B ID
CAH271307-00
Entity Address
915 FOURTH STREET NW
CHOTEAU, MT 59422
Medicare Provider Number
271307
Participating Start Date
1/1/2024
Last Recertification Date
8/27/2024
Pharmacy Details
Pharmacy Name
CHOTEAU DRUG, INC
Pharmacy Address
102 MAIN AVE N
CHOTEAU, MT 59422
Pharmacy Comments
Contract Details
Approval Date
12/7/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Louie King, President
(406) 466-5763 Ext: 6001
Contract Pharmacy Representative
Choteau Drug Inc.
Rolfe Davidson, Pharmacist / Owner
(406) 466-2700
Signed By Date
10/4/2023
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