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SHOPKO PHARMACY #2766
CHC29012-03 MARIAS HEALTHCARE SERVICES INC
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Covered Entity Details
Entity Name
MARIAS HEALTHCARE SERVICES INC
Subdivision Name
Marias Healthcare Services - Dentistry
Type
HRSA-Funded Health Center
340B ID
CHC29012-03
Entity Address
865 OILFIELD AVE
SHELBY, MT 59474-2702
Grant Number
H80CS29012
Participating Start Date
1/1/2016
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
SHOPKO PHARMACY #2766
Pharmacy Address
1950 W ROOSEVELT HWY
SHELBY, MT 59474
Pharmacy Comments
Contract Details
Approval Date
7/12/2016
Contract Begin Date
10/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
2/28/2019
Pharmacy closed
Contacts
Covered Entity Signing Official
Jamie F Brownell, CEO
(406) 434-3110
Contract Pharmacy Representative
ShopKo
Lorie Neumann, Contracting & Compliance
(920) 429-4726
Signed By Date
7/12/2016
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