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BILLINGS CLINIC SPECIALTY PHARMACY
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
BILLINGS CLINIC SPECIALTY PHARMACY
Pharmacy Address
1015 BROADWATER AVE STE 101
BILLINGS, MT 59102
Pharmacy Comments
Contract Details
Approval Date
10/10/2017
Contract Begin Date
1/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/6/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Connie Prewitt, Vice President/Chief Financial Officer
(406) 238-2134
Contract Pharmacy Representative
Billings Clinic Specialty Supplies and Services, LLC
Tracey Murrish, Manager, Specialty Pharmacy
(406) 657-4546
Signed By Date
10/10/2017
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