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INTERMOUNTAIN HEALTH GOOD SAMARITAN HOSP
CAH271347-00 Holy Rosary Healthcare dba Intermountain Health Holy Rosary Hospital
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Covered Entity Details
Entity Name
Holy Rosary Healthcare dba Intermountain Health Holy Rosary Hospital
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH271347-00
Entity Address
2600 Wilson Street
Miles City, MT 59301
Medicare Provider Number
271347
Participating Start Date
10/1/2011
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
INTERMOUNTAIN HEALTH GOOD SAMARITAN HOSP
Pharmacy Address
PHARMACY DEPT
200 EXEMPLA CIR
LAFAYETTE, CO 80026
Pharmacy Comments
Contract Details
Approval Date
10/12/2015
Contract Begin Date
1/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
11/20/2019
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Paul Lewis, CEO
(406) 233-2602
Contract Pharmacy Representative
SCL Health
Daniel Madrid, Pharmacy Manager
(303) 691-6121
Signed By Date
10/12/2015
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