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WAL-MART PHARMACY 10-2923
DSH270004 BILLINGS CLINIC
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Covered Entity Details
Entity Name
BILLINGS CLINIC
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH270004
Entity Address
2800 TENTH AVENUE NORTH
BILLINGS, MT 59101
Medicare Provider Number
270004
Participating Start Date
1/1/2016
Last Recertification Date
8/20/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-2923
Pharmacy Address
1649 MAIN STREET
BILLINGS, MT 59105
Pharmacy Comments
Contract Details
Approval Date
12/1/2015
Contract Begin Date
1/1/2016
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Lu Byrd, Vice President/Hospital Operations
(406) 238-2328
Contract Pharmacy Representative
Healdsburg District Hospital
Kathi Phelps, Manager Contracting
(479) 277-3719
Signed By Date
12/1/2015
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