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WALGREEN CO.
CAH271325-00 St. Luke Community Hospital & Nursing Home
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Covered Entity Details
Entity Name
St. Luke Community Hospital & Nursing Home
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH271325-00
Entity Address
107 6th Avenue SW
Ronan, MT 59864
Medicare Provider Number
271325
Participating Start Date
10/1/2013
Last Recertification Date
8/20/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA WALGREENS #16084
40770 MT HWY 35
POLSON, MT 59860
Pharmacy Comments
Contract Details
Approval Date
10/14/2015
Contract Begin Date
1/1/2016
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Paul Soukup, CFO
(406) 676-4441 Ext: 291
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/14/2015
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