340B Drug Pricing Program Database


CHC26601-03 Full Circle Health, Inc. (Active) - information as of 5/11/2025 11:44:43 PM

Main Details
Full Circle Health, Inc.
Full Circle Health - Idaho Street
HRSA-Funded Health Center
BPS-H80-027740
CHC26601-03
H80CS26601


Additional Details
Active
10/10/2014
1/1/2015
10/16/2014
2/13/2025

Contacts

Family Medicine Residency of Idaho
Tad Arnt, Chief Operating Officer
(208) 514-2500 Ext: 1104

Family Medicine Residency of Idaho
Jared L Moore, Director of Pharmacy
(208) 514-2500 Ext: 7040

Addresses

325 W Idaho St
Boise, ID 83702-6040

Full Circle Health
6565 W Emerald Street
Boise, ID 83704


  • Comments
  • Medicaid Billing
  • Shipping Addresses
  • Contract Pharmacies
  • Grantee Sites
  • Grantee Sites Contract Pharmacies
  • History
Comments
CommentLast Updated On 
No records to display.
Medicaid Billing

Yes
StateMedicaid NumberNPI Number
ID1710525829,1891047791,1841490075,1669125548,11642673731710525829,1841490075,1891047791,1669125548,1164267373
OR18414900751841490075
Shipping Addresses

Full Circle Health
6565 W Emerald Street
Boise, ID 83704
Grantee Sites
340B ID 340B StatusSiteIdNameSub NameAddressAddress Cont.CityState
CHC26601-00ActiveBPS-H80-013100Full Circle Health, Inc.Full Circle Health - Meridian2275 S Eagle Rd STE 120 MeridianID
CHC26601-01ActiveBPS-H80-013204Full Circle Health, Inc.Full Circle Health - Kuna708 E Wythe Creek Ct STE 103 KunaID
CHC26601-02TerminatedBPS-H80-013174Full Circle Health, Inc.Full Circle Health - Meridian Schools Clinic925 NW 1st St MeridianID
CHC26601-03ActiveBPS-H80-027740Full Circle Health, Inc.Full Circle Health - Idaho Street325 W Idaho St BoiseID
CHC26601-04ActiveBPS-H80-018070Full Circle Health, Inc.Full Circle Health - Emerald6565 W Emerald St BoiseID
CHC26601-05ActiveBPS-H80-014128Full Circle Health, Inc.Full Circle Health - Raymond777 N Raymond St BoiseID
CHC26601-06TerminatedBPS-H80-016923FAMILY MEDICINE RESIDENCY OF IDAHOFamily Medicine Health Center-Garden City215 W 35th St Garden CityID
CHC26601-07ActiveBPS-H80-020879Full Circle Health, Inc.Full Circle Health - Nampa South215 East Hawaii Ave Ste 140 NampaID
CHC26601-08TerminatedBPS-H80-020927Family Medicine Residency Of IdahoFamily Medicine Health Center – Meridian Pediatrics3277 E LOUISE DR STE 220 MeridianID
CHC26601-09TerminatedBPS-H80-031706Family Medicine Residency Of IdahoTemporary Site - Family Medicine Health Center, Respite Site-Red Lion Hotel, Rooms 301-3481800 W Fairview Ave Rm 301-348 BoiseID
CHC26601-10TerminatedBPS-H80-030683Family Medicine Residency Of IdahoTemporary Site-Family Medicine Health Center, Mobile Van777 N Raymond St BoiseID
CHC26601-11ActiveBPS-H80-030892Full Circle Health, Inc.Full Circle Health - Nampa North9850 W St Luke's Drive # 329 NampaID
CHC26601-12TerminatedBPS-H80-031290Family Medicine Residency Of IdahoFamily Medicine Health Center, Nampa South Peds215 E Hawaii Ave Ste 390 NampaID
CHC26601-13ActiveBPS-H80-035836FULL CIRCLE HEALTH, INC.Full Circle Health - Boise Pediatrics8610 W Overland Rd BoiseID
CHC26601-14ActiveBPS-H80-036680FULL CIRCLE HEALTH, INC.Full Circle Health - Caldwell315 E Elm St # 201 CaldwellID
Grantee Sites Contract Pharmacies
340B IDPharmacy NameAddressAddress Cont.CityStateZip CodeBegin DateCarve-In Effective DateTermination Date
CHC26601-00ACCREDO HEALTH GROUP INC1620 CENTURY CENTER PKWY # 109
MEMPHISTN38134-884904/01/2022  
CHC26601-00ACCREDO HEALTH GROUP INC3000 ERICSSON DRIVE, SUITE 100
WARRENDALEPA15086-750204/01/2022  
CHC26601-00ACCREDO HEALTH GROUP INC2040 W RIO SALADO PKWY STE 101B
TEMPEAZ85281-201004/01/2022  
CHC26601-00ACCREDO HEALTH GROUP, INC.2825 W PERIMETER RD STE 112
INDIANAPOLISIN4624104/01/2022  
CHC26601-00ACCREDO HEALTH GROUP, INC.6272 LEE VISTA BLVD STE 100
ORLANDOFL3282204/01/2022  
CHC26601-00ACCREDO HEALTH GROUP, INC.2 BOULDEN CIR STE 1
NEW CASTLEDE19720-349204/01/2022  
CHC26601-00ACCREDO HEALTH GROUP, INC.4750 E 450 S SUITE A
WHITESTOWNIN4607504/01/2022  
CHC26601-00ALBERTSONS LLCSAV-ON PHARMACY #126 640 HIGHWAY 16
EMMETTID8361704/01/2017  
CHC26601-00ALBERTSONS LLCSAV-ON PHARMACY #164 20 EAST FAIRVIEW AVE
MERIDIANID83642-173204/01/2017  
CHC26601-00ALBERTSONS LLCSAV-ON PHARMACY #180 3301 WEST CHERRY LANE
MERIDIANID8364204/01/2017 01/27/2022
CHC26601-00ALBERTSONS LLCALBERTSONS PHARMACY #199 1219 S BROADWAY AVE
BOISEID8370604/01/2017  
CHC26601-00ALBERTSONS LLCSAV-ON PHARMACY #169 909 EAST PARKCENTER BLVD
BOISEID8370604/01/2017 01/27/2022
CHC26601-00ALBERTSONS LLCSAV-ON PHARMACY #162 5100 OVERLAND RD
BOISEID8370504/01/2017  
CHC26601-00ALBERTSONS LLCSAV-ON PHARMACY #166 2500 BLAINE ST
CALDWELLID8360504/01/2017 01/27/2022
CHC26601-00ALBERTSONS LLCSAV-ON PHARMACY #101 1650 W. STATE STREET
BOISEID8370204/01/2017  
CHC26601-00ALBERTSONS LLCSAV-ON PHARMACY #165 528 NORTH MAIN ST
MOUNTAIN HOMEID8364704/01/2017 01/27/2022
CHC26601-00ALBERTSONS LLCSAV-ON PHARMACY #176 2400 12TH AVENUE RD
NAMPAID8368604/01/2017  
CHC26601-00ALBERTSONS LLCSAV-ON PHARMACY #154 1520 NORTH COLE RD
BOISEID8370404/01/2017  
CHC26601-00ALBERTSONS LLCSAV-ON PHARMACY #160 10500 OVERLAND RD
BOISEID8370904/01/2017  
CHC26601-00ALBERTSONS LLCSAV-ON PHARMACY #156 7100 WEST STATE ST.
BOISEID8371404/01/2017  
CHC26601-00ALBERTSONS LLCSAV-ON PHARMACY #3337 700 E AVALON ST
KUNAID8363404/01/2017  
CHC26601-00ALBERTSONS LLCSAV-ON PHARMACY #182 250 SOUTH EAGLE RD
EAGLEID8361604/01/2017  
CHC26601-00ALBERTSONS LLCSAV-ON PHARMACY #161 10700 USTICK RD
BOISEID8371304/01/2017  
CHC26601-00ALBERTSONS LLCSAV-ON PHARMACY #189 3614 WEST STATE ST
BOISEID8370304/01/2017  
CHC26601-00ALBERTSONS LLCSAV-ON PHARMACY #168 405 S MAIN ST
PAYETTEID8366104/01/2017  
CHC26601-00ALBERTSONS LLCSAV-ON PHARMACY #193 1653 S. VISTA AVE
BOISEID8370504/01/2017  
CHC26601-00ALBERTSONS LLCSAV-ON PHARMACY #177 4700 NORTH EAGLE RD
BOISEID8371304/01/2017  
CHC26601-00ALBERTSONS LLCSAV-ON PHARMACY #1602 715 12TH AVE S
NAMPAID8365101/01/2024  
CHC26601-00ALBERTSONS LLCSAV-ON PHARMACY #169 909 EAST PARKCENTER BLVD
BOISEID8370601/01/2024  
CHC26601-00ALBERTSONS LLCSAV-ON PHARMACY #3366 20 E WYOMING AVE
HOMEDALEID8362801/01/2024  
CHC26601-00BIOPLUS SPECIALTY PHARMACY SERVICES, LLC13925 YALE AVE STE 145
IRVINECA92620-267001/01/2024 09/03/2024
CHC26601-00BIOPLUS SPECIALTY PHARMACY SERVICES, LLC4900 PROSPECTUS DR STE 300
DURHAMNC2771301/01/2024 09/03/2024
CHC26601-00BIOPLUS SPECIALTY PHARMACY SERVICES, LLC376 NORTHLAKE BLVD
ALTAMONTE SPRINGSFL32701-526101/01/2024 09/03/2024
CHC26601-00CAREMARK FLORIDA SPECIALTY PHARMACY LLCDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 7930 WOODLAND CENTER BLVD STE 500
TAMPAFL3361404/01/2023  
CHC26601-00CAREMARK ILLINOIS SPECIALTY PHARMACY, LLDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 800 BIERMANN CT STE B
MOUNT PROSPECTIL6005604/01/2023  
CHC26601-00CAREMARK KANSAS SPECIALTY PHARMACYCVS/SPECIALTY OR CARELONRX SPECIALTY PHA 11162 RENNER BLVD
LENEXAKS6621904/01/2023  
CHC26601-00CAREMARK MASSACHUSETTS SPECIALTY PHARMACDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 25 BIRCH STREET, BLDG B, SUITE 100
MILFORDMA0175704/01/2023  
CHC26601-00CAREMARK MICHIGAN SPECIALTY PHARMACY, LLDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 1307 ALLEN DR STE H
TROYMI4808304/01/2023  
CHC26601-00CAREMARK NEW JERSEY SPECIALTY PHCY, LLCDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 180 PASSAIC AVE UNIT B-5
FAIRFIELDNJ0700404/01/2023  
CHC26601-00CAREMARK NORTH CAROLINA SPECIALTY PHARMADBA CVS/SPECIALTY OR CARELONRX SPECIALTY 10700 WORLD TRADE BLVD STE 110
RALEIGHNC2761704/01/2023  
CHC26601-00CAREMARK TENNESSEE SPECIALTY PHARMACY, LDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 8370 WOLF LAKE DR
STE 107 		BARTLETTTN3813304/01/2023  
CHC26601-00CAREMARK, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 1127 BRYN MAWR AVE
SUITE A 		REDLANDSCA9237404/01/2023  
CHC26601-00CAREMARK, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 7251 S. EASTERN AVE.
LAS VEGASNV8911904/01/2023  
CHC26601-00CVS CAREMARKDBA CVS/CAREMARK OR CF# 11506 1 GREAT VALLEY BOULEVARD
WILKES BARREPA1870604/01/2023  
CHC26601-00CVS CAREMARK ADVANCED TECHNOLOGY PHARMACDBA CVS/CAREMARK 48067 1780 WALL ST
MT PROSPECTIL6005604/01/2023  
CHC26601-00CVS/SPECIALTY OR CARELONRX SPECIALTY PHACAREMARK, LLC 1001 SPINKS ROAD, STE 280
FLOWER MOUNDTX7502804/01/2023  
CHC26601-00CYSTIC FIBROSIS SERVICESCYSTIC FIBROSIS SERVICES, INC 10530 JOHN W ELLIOTT DR, STE 200
FRISCOTX7503307/01/2015 08/09/2017
CHC26601-00CYSTIC FIBROSIS SERVICES, LLCDBA WALGREENS SPECIALTY PHARMACY #16280 10530 JOHN W ELLIOTT DR STE 200
FRISCOTX7503307/01/2017  
CHC26601-00DOGWOOD PHARMACY LLCD/B/A MEDSCRIPTS MEDICAL PHARMACY 1325 MILLER RD
STE K 		GREENVILLESC29607-654101/01/2024 09/03/2024
CHC26601-00ESI MAIL PHARMACY SERVICEDBA EXPRESS SCRIPTS 7909 S HARDY DR STE 106
TEMPEAZ85284-111204/01/2022  
CHC26601-00EXPRESS SCRIPTSESI MAIL PHARMACY SERVICE INC 4600 N HANLEY RD
SAINT LOUISMO6313404/01/2022  
CHC26601-00EXPRESS SCRIPTS PHARMACY, INC.DBA EXPRESS SCRIPTS 2040 ROUTE 130 NORTH
BURLINGTONNJ0801604/01/2022  
CHC26601-00EXPRESS SCRIPTS PHARMACY, INC.DBA EXPRESS SCRIPTS 4750 E. 450 S.
WHITESTOWNIN4607504/01/2022  
CHC26601-00FRED MEYER5230 W. FRANKLIN ROAD
BOISEID83705-110904/01/2017  
CHC26601-00FRED MEYER800 YELLOWSTONE AVENUE
POCATELLOID83201-446104/01/2017 08/26/2019
CHC26601-00FRED MEYER5425 CHINDEN BLVD
GARDEN CITYID83714-146804/01/2017  
CHC26601-00FRED MEYER10751 WEST OVERLAND ROAD
BOISEID83709-133004/01/2017  
CHC26601-00FRED MEYER1850 EAST FAIRVIEW AVENUE
MERIDIANID8364204/01/2017  
CHC26601-00FRED MEYER50 SECOND STREET SOUTH
NAMPAID83651-370004/01/2017  
CHC26601-00FRED MEYER PHARMACY #6851400 WEST CHINDEN BLVD
MERIDIANID8364604/01/2017  
CHC26601-00HEALTHY OPTIONS INCDBA POSTAL PRESCRIPTION SVCS 3500 SE 26TH AVE
PO BOX 2718 		PORTLANDOR9720204/01/2017  
CHC26601-00IDAHO CVS PHARMACY, L.L.C.CVS/PHARMACY # 11169 7402 WEST FAIRVIEW AVE
BOISEID8370404/01/2023  
CHC26601-00IDAHO CVS PHARMACY, L.L.C.CVS PHARMACY # 17284 16300 N MARKET PLACE BLVD
NAMPAID8368704/01/2023  
CHC26601-00K MART PHARMACY #31891813 CALDWELL BLVD
NAMPAID8365104/01/2017 08/20/2018
CHC26601-00PRIME THERAPEUTICS SPECIALTY PHARMACY LLALLIANCERX WALGREENS PRIME #16568 2354 COMMERCE PARK DRIVE
SUITE 100 		ORLANDOFL32819-999210/01/2017 04/01/2022
CHC26601-00PROCARE PHARMACY DIRECT, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 105 MALL BOULEVARD
MONROEVILLEPA1514604/01/2023  
CHC26601-00PROCARE PHARMACY, L.L.C.DBA: CVS/PHARMACY #2909 1521 4TH AVE., SOUTH
BIRMINGHAMAL3523304/01/2023  
CHC26601-00PROCARE PHARMACY, L.L.C.DBA CVS/PHARMACY #2923 3250 HARDEN ST. EXT. SUITE #300
COLUMBIASC2920304/01/2023  
CHC26601-00PROCARE PHARMACY, L.L.C.DBA CVS/PHARMACY OR CARELONRX SPECIALTY ONE WATERFRONT PLAZA
500 ALA MOANA BLVD., BLDG 1 		HONOLULUHI9681304/01/2023  
CHC26601-00PROCARE PHARMACY, L.L.C.DBA CVS/PHARMACY #2819 1309 NW 23RD AVE.
PORTLANDOR9721004/01/2023  
CHC26601-00RAINA RX LLCDBA ROUTE 300 PHARMACY 1208 ROUTE 300
SUITE 103 		NEWBURGHNY1255001/01/2024 09/03/2024
CHC26601-00RIVER MEDICAL PHARMACY LLC4752 RESEARCH DR
SAN ANTONIOTX78240-500201/01/2024 09/03/2024
CHC26601-00SANTA BARBARA SPECIALTY PHARMACY LLC4690 CARPINTERIA AVE STE B
CARPINTERIACA9301301/01/2024 09/03/2024
CHC26601-00SHOPKO PHARMACY #20642100 CALDWELL BLVD
NAMPAID83651-151004/01/2017 01/11/2019
CHC26601-00SHOPKO PHARMACY #20658105 W FAIRVIEW AVE
BOISEID83704-849504/01/2017 01/11/2019
CHC26601-00SHOPKO PHARMACY #20952655 SOUTH BROADWAY AVE
BOISEID8370604/01/2017 01/11/2019
CHC26601-00SMITH'S DRUG KING #86SMITH'S FOOD KING #1 70 YELLOW CREEK RD
EVANSTONWY8293004/01/2017 08/14/2017
CHC26601-00THRIFTY PAYLESS, INC.RITE AID #5413 1515 WEST STATE STREET
BOISEID8370204/01/2022 02/17/2024
CHC26601-00THRIFTY PAYLESS, INC.RITE AID #5400 728 SOUTH WEST 4TH AVENUE
ONTARIOOR9791404/01/2022 02/17/2024
CHC26601-00THRIFTY PAYLESS, INC.RITE AID #5417 5005 WEST OVERLAND ROAD
BOISEID8370504/01/2022 11/09/2023
CHC26601-00THRIFTY PAYLESS, INC.RITE AID #5412 1600 NORTH MAIN STREET
MERIDIANID8364204/01/2022 09/29/2023
CHC26601-00THRIFTY PAYLESS, INC.RITE AID #5415 10600 FAIRVIEW AVENUE
BOISEID8371304/01/2022 01/18/2024
CHC26601-00WAL-MART CENTRAL FILL 10-2670608 SPRING HILL DR # 3 SUITE 300
SPRINGTX7738610/01/2017 11/17/2018
CHC26601-00WAL-MART PHARMACY 10-19954240 YELLOWSTONE AVENUE
CHUBBUCKID8320204/01/2017 11/17/2018
CHC26601-00WAL-MART PHARMACY 10-25088300 WEST OVERLAND ROAD
BOISEID8370904/01/2017 11/17/2018
CHC26601-00WAL-MART PHARMACY 10-28617319 WEST STATE STREET PO BOX 1407
GARDEN CITYID8371404/01/2017 11/17/2018
CHC26601-00WAL-MART PHARMACY 10-59979600 PARKSOUTH CT. SUITE 100
ORLANDOFL3283710/01/2017 11/17/2018
CHC26601-00WALGREEN CODBA: WALGREENS #10604 1625 S MERIDIAN RD
MERIDIANID83642-600207/01/2015  
CHC26601-00WALGREEN CODBA: WALGREENS #10672 2219 12TH AVE RD
NAMPAID83686-631307/01/2015  
CHC26601-00WALGREEN CODBA: WALGREENS #11541 4110 S. 10TH AVENUE
CALDWELLID8360507/01/2015  
CHC26601-00WALGREEN CODBA: WALGREENS #12123 3395 S. FEDERAL WAY
BOISEID8370507/01/2015 02/27/2024
CHC26601-00WALGREEN CODBA: WALGREENS #11452 3263 N EAGLE RD
MERIDIANID8364607/01/2024  
CHC26601-00WALGREEN CO.DBA: WALGREENS # 01221 3212 E CHINDEN BLVD
EAGLEID8361607/01/2015 02/21/2018
CHC26601-00WALGREEN CO.DBA: WALGREENS # 01972 6725 N GLENWOOD ST
BOISEID8371407/01/2015  
CHC26601-00WALGREEN CO.DBA: WALGREENS # 04942 8100 W FAIRVIEW AVE.
BOISEID8370407/01/2015  
CHC26601-00WALGREEN CO.DBA: WALGREENS # 05184 10580 W USTICK RD
BOISEID8370407/01/2015  
CHC26601-00WALGREEN CO.DBA: WALGREENS # 05185 4924 OVERLAND RD
BOISEID8370507/01/2015  
CHC26601-00WALGREEN CO.DBA: WALGREENS # 05565 10555 W OVERLAND RD
BOISEID8370907/01/2015  
CHC26601-00WALGREEN CO.DBA: WALGREENS # 05648 700 12TH AVENUE S
NAMPAID8365107/01/2015  
CHC26601-00WALGREEN CO.DBA: WALGREENS # 06200 1570 E FAIRVIEW AVE
MERIDIANID8364207/01/2015  
CHC26601-00WALGREEN CO.DBA: WALGREENS # 07276 1012 CLEVELAND BLVD
CALDWELLID83605-385207/01/2015  
CHC26601-00WALGREEN CO.DBA: WALGREENS # 10197 3150 W CHERRY LANE
MERIDIANID83642-112207/01/2015  
CHC26601-00WALGREEN CO.DBA: WALGREENS #11083 6195 S FIVE MILE
BOISEID8370907/01/2015  
CHC26601-00WALGREEN CO.DBA; WALGREENS #13614 869 E AVALON ST
KUNAID8363407/01/2015  
CHC26601-00WALGREEN CO.DBA: WALGREENS #13888 455 S. BROADWAY AVE.
BOISEID8370207/01/2015  
CHC26601-00WALGREEN CO.DBA: WALGREENS #12483 932 CALDWELL BLVD
NAMPAID8365101/01/2024  
CHC26601-00WALGREEN CO.DBA: WALGREENS #11687 4850 N LINDER RD
MERIDIANID8364601/01/2024  
CHC26601-00WALGREEN CO.DBA: WALGREENS # 06971 2285 S APPLE STREET
BOISEID83706-673101/01/2025  
CHC26601-00Walgreens #21435Walgreens Central Fill #21435 6306 S Airport Rd
West JordanUT84084-560107/01/2024  
CHC26601-00WALGREENS SPECIALTY PHARMACY, LLCDBA WALGREENS SPECIALTY PHARMACY #16287 130 ENTERPRISE DR
PITTSBURGHPA1527507/01/2015  
CHC26601-00WALGREENS SPECIALTY PHARMACY, LLCALLIANCERX WALGREENS PRIME #12314 9775 SW GEMINI DR, STE 1
BEAVERTONOR9700807/01/2015 11/04/2021
CHC26601-00WALGREENS SPECIALTY PHARMACY, LLCDBA WALGREENS SPECIALTY PHARMACY #15438 41460 HAGGERTY CIR S
CANTONMI4818807/01/2015  
CHC26601-00WALGREENS SPECIALTY PHARMACY, LLCDBA WALGREENS SPECIALTY PHARMACY #15443 10530 JOHN W ELLIOTT DR STE 100
FRISCOTX7503307/01/2015  
History
SectionFieldActionActivityValue BeforeValue AfterTimestamp 
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False2/13/2025 5:12 PM
Medicaid BillingMedicaid: NumberInsertRecertification 11642673732/13/2025 5:12 PM
Medicaid BillingMedicaid: StateInsertRecertification ID2/13/2025 5:12 PM
Medicaid BillingNPI: NumberInsertRecertification 11642673732/13/2025 5:12 PM
Medicaid BillingNPI: StateInsertRecertification ID2/13/2025 5:12 PM
DetailsLast Recertification DateUpdateRecertification2/8/2024 4:16:31 PM2/13/2025 5:12:30 PM2/13/2025 5:12 PM
DetailsLast Recertification DateUpdateRecertification2/14/2023 7:25:24 AM2/8/2024 4:16:31 PM2/8/2024 4:16 PM
AddressesBilling AddressInsertRecertification Full Circle Health 6565 W Emerald Street Boise, ID 837042/14/2023 7:25 AM
AddressesShipping AddressInsertRecertification Full Circle Health 6565 W Emerald Street Boise, ID 837042/14/2023 7:25 AM
DetailsLast Recertification DateUpdateRecertification2/4/2022 10:16:25 AM2/14/2023 7:25:24 AM2/14/2023 7:25 AM
DetailsEntity SubnameUpdateRecertificationFamily Medicine Health Center-Idaho StreetFull Circle Health - Idaho Street2/14/2023 7:25 AM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False11/30/2022 3:14 PM
Medicaid BillingMedicaid: NumberInsertChange Request 166912554811/30/2022 3:14 PM
Medicaid BillingMedicaid: StateInsertChange Request ID11/30/2022 3:14 PM
Medicaid BillingNPI: NumberInsertChange Request 166912554811/30/2022 3:14 PM
Medicaid BillingNPI: StateInsertChange Request ID11/30/2022 3:14 PM
DetailsEntity NameUpdateGroup Change RequestFamily Medicine Residency Of IdahoFull Circle Health, Inc.9/12/2022 1:45 PM
ContactsPrimary ContactUpdateGroup Change RequestRobin, Michelle Sr. Director, Grant Compliance Family Medicine Residency of Idaho, Inc. (The) 2088607299Moore, Jared L Director of Pharmacy Family Medicine Residency of Idaho 2085142500-70406/30/2022 10:25 AM
DetailsLast Recertification DateUpdateRecertification2/11/2021 10:50:41 AM2/4/2022 10:16:25 AM2/4/2022 10:16 AM
ContactsAuthorizing OfficialUpdateGroup Change RequestAllen, Sabrina Sr. Director of Pharmacy Services Family Medicine Residency of Idaho, Inc. (The) 2085142500-7040Arnt, Tad Chief Operating Officer Family Medicine Residency of Idaho 2085142500-11049/1/2021 2:10 PM
Medicaid BillingNPI: NumberDeleteRecertification1891047791 ( ) 2/11/2021 10:50 AM
Medicaid BillingNPI: NumberDeleteRecertification1841490075 ( ) 2/11/2021 10:50 AM
Medicaid BillingNPI: NumberInsertRecertification 17105258292/11/2021 10:50 AM
Medicaid BillingNPI: StateInsertRecertification ID2/11/2021 10:50 AM
Medicaid BillingNPI: NumberInsertRecertification 18414900752/11/2021 10:50 AM
Medicaid BillingNPI: StateInsertRecertification ID2/11/2021 10:50 AM
Medicaid BillingNPI: NumberInsertRecertification 18910477912/11/2021 10:50 AM
Medicaid BillingNPI: StateInsertRecertification ID2/11/2021 10:50 AM
DetailsLast Recertification DateUpdateRecertification2/3/2020 11:03:58 AM2/11/2021 10:50:41 AM2/11/2021 10:50 AM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False8/10/2020 4:51 PM
Medicaid BillingMedicaid: NumberInsertChange Request 18414900758/10/2020 4:51 PM
Medicaid BillingMedicaid: StateInsertChange Request OR8/10/2020 4:51 PM
Medicaid BillingNPI: NumberInsertChange Request 18414900758/10/2020 4:51 PM
Medicaid BillingNPI: StateInsertChange Request OR8/10/2020 4:51 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False4/1/2020 5:50 PM
Medicaid BillingMedicaid: NumberInsertChange Request 17105258294/1/2020 5:50 PM
Medicaid BillingMedicaid: StateInsertChange Request ID4/1/2020 5:50 PM
DetailsLast Recertification DateUpdateRecertification2/14/2019 12:32:04 PM2/3/2020 11:03:58 AM2/3/2020 11:03 AM
AddressesMain AddressUpdateChange Request 121 E Fort St Boise, ID 83712-6322 325 W Idaho St Boise, ID 83702-60409/25/2019 4:27 PM
DetailsEntity SubnameUpdateChange RequestFamily Medicine Health Center-Fort StreetFamily Medicine Health Center-Idaho Street9/25/2019 4:27 PM
ContactsPrimary ContactUpdateChange RequestSherwood, Heather 340B Analyst Family Medicine Residency of Idaho, Inc. (The) 2085142500-7042Robin, Michelle Sr. Director, Grant Compliance Family Medicine Residency of Idaho, Inc. (The) 20886072996/3/2019 6:36 AM
ContactsAuthorizing OfficialUpdateProfile Change RequestAllen, Sabrina Pharmacy Director Family Medicine Residency of Idaho, Inc. (The) 2085142500-7040Allen, Sabrina Sr. Director of Pharmacy Services Family Medicine Residency of Idaho, Inc. (The) 2085142500-70405/30/2019 4:50 PM
DetailsLast Recertification DateUpdateRecertification2/20/2018 1:37:08 PM2/14/2019 12:32:04 PM2/14/2019 12:32 PM
ContactsAuthorizing OfficialUpdateChange RequestEpperly, Ted President and CEO Family Medicine Residency of Idaho INC 2089548744Allen, Sabrina Pharmacy Director Family Medicine Residency of Idaho, Inc. (The) 2085142500-70408/31/2018 8:54 AM
ContactsPrimary ContactUpdateChange RequestAllen, Sabrina Pharmacy Director Family Medicine Residency of Idaho, Inc. (The) 2085142500-7040Sherwood, Heather 340B Analyst Family Medicine Residency of Idaho, Inc. (The) 2085142500-70428/31/2018 8:54 AM
DetailsIs Authorizing Official EHB DataUpdateChange RequestFalse 8/31/2018 8:54 AM
DetailsLast Recertification DateUpdateRecertification1/26/2017 12:00:00 AM2/20/2018 1:37:08 PM2/20/2018 1:37 PM
ContactsAuthorizing OfficialUpdate Epperly, Ted President and CEO 2089548744Epperly, Ted President and CEO Family Medicine Residency of Idaho INC 208954874411/16/2017 2:43 PM
ContactsPrimary ContactUpdate Allen, Sabrina Pharmacy Director 2085142500-7040Allen, Sabrina Pharmacy Director Family Medicine Residency of Idaho, Inc. (The) 2085142500-70409/25/2017 5:38 PM
ContactsAuthorizing OfficialInsert  Epperly, Ted President and CEO 20895487448/14/2017 6:02 PM
ContactsPrimary ContactInsert  Allen, Sabrina Pharmacy Director 2085142500-70402/13/2017 6:42 AM
ContactsSigned ByInsert  Bevans, Steve CFO/COO 20895486802/13/2017 6:42 AM
AddressesMain AddressInsert   121 E Fort St Boise, ID 83712-63221/26/2017 12:10 PM
DetailsLast Recertification DateUpdate 2/26/2016 12:00:00 AM1/26/2017 12:00:00 AM1/26/2017 12:10 PM
DetailsLast Recertification DateUpdate 2/11/2015 12:00:00 AM2/26/2016 12:00:00 AM2/26/2016 11:26 AM
DetailsLast Recertification DateUpdate  2/11/2015 12:00:00 AM2/11/2015 11:13 AM
DatesParticipating Approval DateUpdate  10/16/2014 12:00:00 AM10/16/2014 4:58 PM
DetailsStateUpdate PendingActive10/16/2014 4:58 PM
DatesStart DateUpdate  1/1/2015 12:00:00 AM10/16/2014 4:58 PM
Details340B IDUpdate ONLINE_REG_46989CHC26601-0310/10/2014 1:34 PM
Details340B IDUpdate ONLINE_REGONLINE_REG_4698910/10/2014 12:16 PM
Medicaid BillingMedicaid: Is PrimaryInsert  False10/10/2014 12:16 PM
Medicaid BillingMedicaid: NumberInsert  189104779110/10/2014 12:16 PM
Medicaid BillingMedicaid: StateInsert  ID10/10/2014 12:16 PM
Medicaid BillingMedicaid: Is PrimaryInsert  False10/10/2014 12:16 PM
Medicaid BillingMedicaid: NumberInsert  184149007510/10/2014 12:16 PM
Medicaid BillingMedicaid: StateInsert  ID10/10/2014 12:16 PM
Medicaid BillingNPI: NumberInsert  189104779110/10/2014 12:16 PM
Medicaid BillingNPI: NumberInsert  184149007510/10/2014 12:16 PM
DetailsLast Recertification DateInsert   10/10/2014 12:16 PM
DetailsGrant NumberInsert  H80CS2660110/10/2014 12:16 PM
Details340B IDInsert  ONLINE_REG10/10/2014 12:16 PM
DetailsIs Authorizing Official EHB DataInsert  False10/10/2014 12:16 PM
DatesLast Date That 340B Drugs PurchasedInsert   10/10/2014 12:16 PM
DetailsMedicare Provider NumberInsert   10/10/2014 12:16 PM
DetailsEntity NameInsert  Family Medicine Residency Of Idaho10/10/2014 12:16 PM
DetailsProgram CodeInsert  CH10/10/2014 12:16 PM
DetailsEntity SubnameInsert  Family Medicine Health Center-Fort Street10/10/2014 12:16 PM
DatesParticipating Approval DateInsert   10/10/2014 12:16 PM
DetailsStateInsert  Pending10/10/2014 12:16 PM
DatesRegistration DateInsert  10/10/2014 12:00:00 AM10/10/2014 12:16 PM
DatesSigned By DateInsert  10/10/2014 12:00:00 AM10/10/2014 12:16 PM
DatesStart DateInsert   10/10/2014 12:16 PM
TerminationsTermination CommentsInsert   10/10/2014 12:16 PM
TerminationsTermination DateInsert   10/10/2014 12:16 PM
TerminationsTermination Effective DateInsert   10/10/2014 12:16 PM
TerminationsTermination ReasonInsert   10/10/2014 12:16 PM