| Contacts | Primary Contact | Update | Profile Change Request | Brower, Brady
Director of Pharmacy
Health West, Inc.
2082327862-1119 | Brower, Brady
Director of Pharmacy
Health West, Inc.
2082327862-1149 | 4/14/2025 11:41 AM |
| Details | Last Recertification Date | Update | Recertification | 1/31/2024 8:52:15 AM | 2/12/2025 12:09:16 PM | 2/12/2025 12:09 PM |
| Details | Last Recertification Date | Update | Recertification | 2/21/2023 1:10:14 PM | 1/31/2024 8:52:15 AM | 1/31/2024 8:52 AM |
| Details | Entity Subname | Update | Recertification | HEALTH WEST - FAMILY MEDICINE CHC | HEALTH WEST - ISU CHC | 1/31/2024 8:52 AM |
| Contacts | Authorizing Official | Update | Group Change Request | Benedetti, Mindy
CEO
Health West, Inc.
2082327862-1120 | Horrocks, Mark T
Chief Medical Officer
Health West Inc.
2082327862 | 1/26/2024 7:15 PM |
| Contacts | Primary Contact | Update | PC Change Request | Piva, Gino J
Director of Pharmacy
Health West Inc
2082327862-1119 | Brower, Brady
Director of Pharmacy
Health West, Inc.
2082327862-1119 | 12/11/2023 4:40 PM |
| Details | Last Recertification Date | Update | Recertification | 2/22/2022 1:03:36 PM | 2/21/2023 1:10:14 PM | 2/21/2023 1:10 PM |
| Details | Last Recertification Date | Update | Recertification | 2/18/2021 5:16:29 PM | 2/22/2022 1:03:36 PM | 2/22/2022 1:03 PM |
| Contacts | Authorizing Official | Update | Profile Change Request | Benedetti, Mindy
CEO
Health West, Inc.
2082327882-1120 | Benedetti, Mindy
CEO
Health West, Inc.
2082327862-1120 | 2/22/2022 1:00 PM |
| Addresses | Main Address | Update | Recertification |
465 Memorial Dr.
Pocatello, ID 83201-4008 |
465 MEMORIAL DR
POCATELLO, ID 83201-4008 | 2/18/2021 5:16 PM |
| Details | Last Recertification Date | Update | Recertification | 2/18/2020 5:10:01 PM | 2/18/2021 5:16:29 PM | 2/18/2021 5:16 PM |
| Details | Last Recertification Date | Update | Recertification | 2/25/2019 10:05:50 AM | 2/18/2020 5:10:01 PM | 2/18/2020 5:10 PM |
| Addresses | Main Address | Update | Recertification |
465 Memorial Drive
Pocatello, ID 83201 |
465 Memorial Dr.
Pocatello, ID 83201-4008 | 2/25/2019 10:05 AM |
| Details | Last Recertification Date | Update | Recertification | 2/20/2018 3:06:36 PM | 2/25/2019 10:05:50 AM | 2/25/2019 10:05 AM |
| Details | Entity Subname | Update | Recertification | Pocatello Family Medicine | HEALTH WEST - FAMILY MEDICINE CHC | 2/25/2019 10:05 AM |
| Details | Last Recertification Date | Update | Recertification | 1/26/2017 12:00:00 AM | 2/20/2018 3:06:36 PM | 2/20/2018 3:06 PM |
| Contacts | Primary Contact | Update | Change Request | Wright, Nancy
Director of Executive Services
Health West Inc.
2082327862-1100 | Piva, Gino J
Director of Pharmacy
Health West Inc
2082327862-1119 | 12/13/2017 3:30 PM |
| Contacts | Authorizing Official | Update | Change Request | Benedetti, Mindy
CEO
2082327882-1120 | Benedetti, Mindy
CEO
Health West, Inc.
2082327882-1120 | 12/6/2017 5:17 PM |
| Contacts | Primary Contact | Update | | Wright, Nancy
Director of Executive Services
2082327862-1100 | Wright, Nancy
Director of Executive Services
Health West Inc.
2082327862-1100 | 12/5/2017 4:31 PM |
| Contacts | Authorizing Official | Insert | | | Benedetti, Mindy
CEO
2082327882-1120 | 7/12/2017 3:34 PM |
| Addresses | Main Address | Insert | | |
465 Memorial Drive
Pocatello, ID 83201 | 1/26/2017 2:07 PM |
| Contacts | Primary Contact | Insert | | | Wright, Nancy
Director of Executive Services
2082327862-1100 | 1/26/2017 2:07 PM |
| Contacts | Signed By | Insert | | | Mahoney, Elizabeth
Chief Executive Officer
2082327862-1107 | 1/26/2017 2:07 PM |
| Details | Last Recertification Date | Update | | 2/22/2016 12:00:00 AM | 1/26/2017 12:00:00 AM | 1/26/2017 2:07 PM |
| Details | Last Recertification Date | Update | | 2/12/2015 12:00:00 AM | 2/22/2016 12:00:00 AM | 2/22/2016 1:18 PM |
| Details | Last Recertification Date | Update | | 3/23/2014 12:00:00 AM | 2/12/2015 12:00:00 AM | 2/12/2015 1:10 PM |
| Details | Last Recertification Date | Update | | | 3/23/2014 12:00:00 AM | 3/23/2014 1:10 PM |
| Addresses | Billing Address | Insert | | | Health West Inc.
PO Box 2377
Pocatello, ID 83206 | 3/1/2013 1:05 PM |
| Details | 340B ID | Update | | IS-FN-CH10018J | CH10018J | 3/1/2013 1:05 PM |
| Details | Entity Name | Update | | Health West Inc | HEALTH WEST, INC. | 3/1/2013 1:05 PM |
| Dates | Participating Approval Date | Update | | | 3/1/2013 12:00:00 AM | 3/1/2013 1:05 PM |
| Details | State | Update | | Pending | Active | 3/1/2013 1:05 PM |
| Dates | Start Date | Update | | | 4/1/2013 12:00:00 AM | 3/1/2013 1:05 PM |
| Details | 340B ID | Update | | FN?-CHC00321-00 | IS-FN-CH10018J | 2/28/2013 3:15 PM |
| Details | 340B ID | Update | | IS-FN-CHC00321-00 | FN?-CHC00321-00 | 2/20/2013 5:24 PM |
| Details | Grant Number | Update | | | H80CS00321 | 2/6/2013 4:17 PM |
| Details | 340B ID | Update | | ONLINE_REG | IS-FN-CHC00321-00 | 2/6/2013 4:17 PM |
| Details | Last Recertification Date | Insert | | | | 1/9/2013 4:00 PM |
| Details | Grant Number | Insert | | | | 1/9/2013 4:00 PM |
| Details | 340B ID | Insert | | | ONLINE_REG | 1/9/2013 4:00 PM |
| Details | Is Authorizing Official EHB Data | Insert | | | | 1/9/2013 4:00 PM |
| Dates | Last Date That 340B Drugs Purchased | Insert | | | | 1/9/2013 4:00 PM |
| Details | Medicare Provider Number | Insert | | | | 1/9/2013 4:00 PM |
| Details | Entity Name | Insert | | | Health West Inc | 1/9/2013 4:00 PM |
| Details | Program Code | Insert | | | CH | 1/9/2013 4:00 PM |
| Details | Entity Subname | Insert | | | Pocatello Family Medicine | 1/9/2013 4:00 PM |
| Dates | Participating Approval Date | Insert | | | | 1/9/2013 4:00 PM |
| Details | State | Insert | | | Pending | 1/9/2013 4:00 PM |
| Dates | Registration Date | Insert | | | 1/9/2013 12:00:00 AM | 1/9/2013 4:00 PM |
| Dates | Signed By Date | Insert | | | 1/9/2013 12:00:00 AM | 1/9/2013 4:00 PM |
| Dates | Start Date | Insert | | | | 1/9/2013 4:00 PM |
| Terminations | Termination Comments | Insert | | | | 1/9/2013 4:00 PM |
| Terminations | Termination Date | Insert | | | | 1/9/2013 4:00 PM |
| Terminations | Termination Effective Date | Insert | | | | 1/9/2013 4:00 PM |
| Terminations | Termination Reason | Insert | | | | 1/9/2013 4:00 PM |