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LOGAN HEALTH PHARMACY CLINICAL
SCH270051-04 KALISPELL REGIONAL MEDICAL CENTER
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Covered Entity Details
Entity Name
KALISPELL REGIONAL MEDICAL CENTER
Subdivision Name
THE BASS BREAST CENTER
Type
Sole Community Hospital
340B ID
SCH270051-04
Entity Address
310 SUNNYVIEW LANE
KALISPELL, MT 59901
Medicare Provider Number
270051
Outpatient Facility Provider Number
Participating Start Date
9/24/2010
Last Recertification Date
8/16/2018
Entity Termination Date
9/13/2018
Pharmacy Details
Pharmacy Name
LOGAN HEALTH PHARMACY CLINICAL
Pharmacy Address
200 CONWAY DR
KALISPELL, MT 59901
Pharmacy Comments
Contract Details
Approval Date
1/1/2011
Contract Begin Date
1/1/2011
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
9/13/2018
Covered Entity Terminated
Contacts
Covered Entity Signing Official
CHARLES PEARCE, C.F.I.O.
(406) 752-1724
Contract Pharmacy Representative
MARK DONALDSON, DIRECTOR OF PHARMACY SERVICES
(406) 756-4701
Signed By Date
12/10/2010
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