Contract Pharmacy Details

SHOPKO PHARMACY #2774
CAH271317-00 Livingston Healthcare

Covered Entity Details

Entity Name

Livingston Healthcare

Subdivision Name

Type

Critical Access Hospital

340B ID

CAH271317-00

Entity Address

320 Alpenglow Lane
Livingston, MT 59047

Medicare Provider Number

271317

Participating Start Date

1/1/2012

Last Recertification Date

8/20/2024

Pharmacy Details

Pharmacy Name

SHOPKO PHARMACY #2774

Pharmacy Address

100 WASHINGTON ST
LIVINGSTON, MT 59047

Pharmacy Comments

Contract Details

Approval Date

1/15/2014

Contract Begin Date

4/1/2014

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

2/20/2019
Pharmacy closed

Contacts

Covered Entity Signing Official

Bren Lowe, CEO
(406) 823-3541 Ext: 6411

Contract Pharmacy Representative

Greg Ahmann, VP Regional Pharmacy
(920) 429-4879

Signed By Date

1/15/2014