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CHOTEAU DRUG
FQHC638543 Northern Cheyenne Tribe
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Covered Entity Details
Entity Name
Northern Cheyenne Tribe
Subdivision Name
Northern Cheyenne Tribal Health
Type
Tribal Contract/Compact with IHS (P.L. 93-638)
340B ID
FQHC638543
Entity Address
600 cheyenne avenue south
box 67
Lame Deer, MT 59043
Grant Number
Participating Start Date
4/1/2016
Last Recertification Date
2/23/2017
Entity Termination Date
4/1/2017
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**NO LONGER VALID - ACQUIRED 03/28/2017*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
3/3/2016
Contract Begin Date
4/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2017
Contacts
Covered Entity Signing Official
Contract Pharmacy Representative
Choteau Drug Inc.
Rolfe Davidson, Pharmacist / Owner
(406) 466-2700
Signed By Date
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