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LIBBY DRUG PC
CAH271320-00 ST. JOHN'S LUTHERAN HOSPITAL DBA CABINET PEAKS MEDICAL CENTER
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Covered Entity Details
Entity Name
ST. JOHN'S LUTHERAN HOSPITAL DBA CABINET PEAKS MEDICAL CENTER
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH271320-00
Entity Address
209 Health Park Drive
LIBBY, MT 59923
Medicare Provider Number
271320
Participating Start Date
4/1/2011
Last Recertification Date
8/21/2024
Pharmacy Details
Pharmacy Name
LIBBY DRUG PC
Pharmacy Address
906 MONTANA AVENUE
LIBBY, MT 59923
Pharmacy Comments
Contract Details
Approval Date
10/6/2014
Contract Begin Date
1/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/8/2016
Pharmacy closed
Contacts
Covered Entity Signing Official
Brigid Burke, CFO
(406) 283-7219
Contract Pharmacy Representative
Rick Jaqueth, Owner
(406) 293-3958
Signed By Date
10/6/2014
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