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CH101188B Community Council of Idaho, Inc. (Active)
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Main Details
Name
Community Council of Idaho, Inc.
Subdivision Name
Community Family Clinic Idaho Falls
Type
HRSA-Funded Health Center
Site ID
BPS-H80-021817
340B ID
CH101188B
Grant Number
H80CS04201
Additional Details
Current Program Status
Active
Registration Date
8/26/2005
Participating Start Date
9/9/2005
Participating Approval Date
8/26/2005
Last Recertification Date
2/13/2025
Contacts
Authorizing Official
Community Council of Idaho
Arnold Cantu, ADMINISTRATOR
(208) 528-7655 Ext: 3519
Primary Contact
Community Council of Idaho
Troy Coulson, Pharmacy Operations Officer
(208) 470-7979
Addresses
Street Address
2100 Alan STREET
IDAHO FALLS, ID 83404
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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