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SHOPKO PHARMACY #2529
CAH271318-00 Barrett Hospital Development Corporation
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Covered Entity Details
Entity Name
Barrett Hospital Development Corporation
Subdivision Name
BARRETT HOSPITAL & HEALTHCARE
Type
Critical Access Hospital
340B ID
CAH271318-00
Entity Address
600 MT Highway 91 South
DILLON, MT 59725-7379
Medicare Provider Number
271318
Participating Start Date
1/1/2014
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
SHOPKO PHARMACY #2529
Pharmacy Address
125 E GLENDALE ST
DILLON, MT 59725
Pharmacy Comments
Contract Details
Approval Date
4/5/2018
Contract Begin Date
7/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
2/7/2019
Pharmacy closed
Contacts
Covered Entity Signing Official
RICHARD ACHTER, CHIEF FINANCIAL OFFICER
(406) 683-3003
Contract Pharmacy Representative
Shopko Pharmacy
Debi Danbury, 340B Program Manager
(920) 429-7613
Signed By Date
4/5/2018
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