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EUREKA DRUG, INC.
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
EUREKA DRUG, INC.
Pharmacy Address
ATTN: PHARMACIST IN CHARGE
546 HIGHWAY 93 NORTH
P. O. BOX 305
EUREKA, MT 59917-0305
Pharmacy Comments
Contract Details
Approval Date
10/14/2014
Contract Begin Date
1/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/8/2016
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Brigid Burke, CFO
(406) 283-7219
Contract Pharmacy Representative
Trevor Erickson, President
(406) 297-7748
Signed By Date
10/14/2014
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