Contract Pharmacy Details

CHOTEAU DRUG
FQHC638541 Blackfeet Tribe

Covered Entity Details

Entity Name

Blackfeet Tribe

Subdivision Name

Southern Piegan Diabetes Progran

Type

Tribal Contract/Compact with IHS (P.L. 93-638)

340B ID

FQHC638541

Entity Address

503 Popimi Street
Browning, MT 59417-0850

Grant Number

Participating Start Date

4/1/2019

Last Recertification Date

Entity Termination Date

4/1/2020

Pharmacy Details

Pharmacy Name

CHOTEAU DRUG

Pharmacy Address

**NO LONGER VALID - ACQUIRED 03/28/2017*
102 MAIN AVE N
CHOTEAU, MT 59422

Pharmacy Comments

Contract Details

Approval Date

1/4/2016

Contract Begin Date

4/1/2016

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

4/1/2018
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Patricia Calf Looking, Administrator
(406) 338-7907 Ext: 3680

Contract Pharmacy Representative

Choteau Drug Inc.
Rolfe Davidson, Pharmacist / Owner
(406) 466-2700

Signed By Date

1/4/2016

340B Drug Pricing Program Database