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INTERMOUNTAIN SPECIALTY PHARMACY - DENVE
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 SPECIALTY PHARMACY - DENVE
Pharmacy Address
1830 N FRANKLIN ST
STE 190
DENVER, CO 80218
Pharmacy Comments
Contract Details
Approval Date
1/9/2017
Contract Begin Date
4/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Paul Lewis, CEO
(406) 233-2602
Contract Pharmacy Representative
SCL Health
Chris Wilson, Pharmacy Manager
(303) 318-1313 Ext: 61313
Signed By Date
1/9/2017
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