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WAL-MART PHARMACY 10-2455
SCH270012-00 BENEFIS HOSPITALS, INC.
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Covered Entity Details
Entity Name
BENEFIS HOSPITALS, INC.
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH270012-00
Entity Address
1101 26TH STREET SOUTH
GREAT FALLS, MT 59405
Medicare Provider Number
270012
Participating Start Date
1/1/2011
Last Recertification Date
8/23/2018
Entity Termination Date
1/1/2019
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-2455
Pharmacy Address
701 SMELTER AVENUE NE
GREAT FALLS, MT 59404
Pharmacy Comments
Contract Details
Approval Date
10/20/2014
Contract Begin Date
1/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/31/2018
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Laura L. Goldhahn, President
(406) 455-5478
Contract Pharmacy Representative
Healdsburg District Hospital
Kathi Phelps, Manager Contracting
(479) 277-3719
Signed By Date
10/20/2014
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