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MANIFEST PHARMACY, LLC
CAH271327-00 Rosebud Community Hospital, Inc. dba Rosebud Health Care Center
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Covered Entity Details
Entity Name
Rosebud Community Hospital, Inc. dba Rosebud Health Care Center
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH271327-00
Entity Address
383 17th Ave N
Forsyth, MT 59327
Medicare Provider Number
271327
Participating Start Date
4/1/2014
Last Recertification Date
8/30/2024
Pharmacy Details
Pharmacy Name
MANIFEST PHARMACY, LLC
Pharmacy Address
1018 S BATESVILLE RD
STE 4A
GREER, SC 29650-5203
Pharmacy Comments
Contract Details
Approval Date
7/14/2014
Contract Begin Date
10/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2018
Agreement registered in error
Contacts
Covered Entity Signing Official
Ryan Tooke, CEO
(406) 346-2161 Ext: 223
Contract Pharmacy Representative
Benjamin Walvoord, President
(864) 990-2880
Signed By Date
7/14/2014
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