Contract Pharmacy Details

MONTANA CVS PHARMACY, L.L.C.
RRC270004-00 Billings Clinic Hospital

Covered Entity Details

Entity Name

Billings Clinic Hospital

Subdivision Name

Type

Rural Referral Center

340B ID

RRC270004-00

Entity Address

2800 10th Ave. N
Billings, MT 59101-4000

Medicare Provider Number

270004

Participating Start Date

1/1/2012

Last Recertification Date

8/17/2015

Entity Termination Date

1/1/2016

Pharmacy Details

Pharmacy Name

MONTANA CVS PHARMACY, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 05302
425 EAST MAIN ST.
BILLINGS, MT 59105

Pharmacy Comments

Contract Details

Approval Date

8/30/2012

Contract Begin Date

8/30/2012

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

1/1/2016
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Lu Byrd, Vice President/Hospital Operations
(406) 238-2328

Contract Pharmacy Representative

CVS
Scott Tierney, Senior Director, Payer Relations
(401) 770-2762

Signed By Date

8/8/2012

340B Drug Pricing Program Database