Contract Pharmacy Details

SHOPKO PHARMACY #2529
CH083270 BUTTE-SILVER BOW PRIMARY HEALTH CARE CLINIC, INC

Covered Entity Details

Entity Name

BUTTE-SILVER BOW PRIMARY HEALTH CARE CLINIC, INC

Subdivision Name

BUTTE-SILVER BOW PRIMARY HEALTH CARE

Type

HRSA-Funded Health Center

340B ID

CH083270

Entity Address

445 Centennial Ave.
Butte, MT 59701-2870

Grant Number

H80CS00799

Participating Start Date

7/1/1998

Last Recertification Date

3/5/2025

Pharmacy Details

Pharmacy Name

SHOPKO PHARMACY #2529

Pharmacy Address

125 E GLENDALE ST
DILLON, MT 59725

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

2/7/2019
Pharmacy closed

Contacts

Covered Entity Signing Official

Jessica Cotton, CEO
(406) 496-6018

Contract Pharmacy Representative

ShopKo
Lorie Neumann, Contracting & Compliance
(920) 429-4726

Signed By Date

7/12/2016

340B Drug Pricing Program Database