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WAL-MART PHARMACY 10-2608
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
WAL-MART PHARMACY 10-2608
Pharmacy Address
3205 STOWER STREET
MILES CITY, MT 59301
Pharmacy Comments
Contract Details
Approval Date
1/15/2016
Contract Begin Date
4/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
8/7/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Paul Lewis, CEO
(406) 233-2602
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
1/15/2016
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