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SHOPKO PHARMACY #2062
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
SHOPKO PHARMACY #2062
Pharmacy Address
301 NORTHWEST BYPASS
GREAT FALLS, MT 59404-4125
Pharmacy Comments
Contract Details
Approval Date
7/14/2016
Contract Begin Date
10/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/31/2018
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Terry Olinger, President
(406) 455-5477
Contract Pharmacy Representative
ShopKo
Lorie Neumann, Contracting & Compliance
(920) 429-4726
Signed By Date
7/14/2016
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