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NORTHTOWN DRUG
FQHCLA257A MARIAS HEALTHCARE SERVICES, INC.
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Covered Entity Details
Entity Name
MARIAS HEALTHCARE SERVICES, INC.
Subdivision Name
Type
Health Center Program Look-Alike
340B ID
FQHCLA257A
Entity Address
422 MONTANA
VALIER, MT 59486
Grant Number
LALCS00043
Participating Start Date
7/1/2010
Last Recertification Date
1/28/2015
Entity Termination Date
1/1/2016
Pharmacy Details
Pharmacy Name
NORTHTOWN DRUG
Pharmacy Address
ANN CLARK
100 MAIN ST
PO BOX 917
SHELBY, MT 59474-1906
Pharmacy Comments
Contract Details
Approval Date
8/17/2012
Contract Begin Date
8/17/2012
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2016
Contacts
Covered Entity Signing Official
Jamie F Brownell, CEO
(406) 434-3110
Contract Pharmacy Representative
Northtown
Ann Clark, Pharmacist
(406) 434-5115
Signed By Date
8/1/2012
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