340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
FRED MEYER STORES, INC
RRC130049-00 KOOTENAI HOSPITAL DISTRICT
Print
Covered Entity Details
Entity Name
KOOTENAI HOSPITAL DISTRICT
Subdivision Name
Type
Rural Referral Center
340B ID
RRC130049-00
Entity Address
2003 KOOTENAI HEALTH WAY
COEUR DALENE, ID 83814
Medicare Provider Number
130049
Participating Start Date
7/1/2025
Last Recertification Date
Pharmacy Details
Pharmacy Name
FRED MEYER STORES, INC
Pharmacy Address
FRED MEYER PHARMACY 351
15609 EAST SPRAGUE AVE
SPOKANE VALLEY, WA 99037
Pharmacy Comments
Contract Details
Approval Date
2/1/2019
Contract Begin Date
4/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2021
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Kim Webb, CFO
(208) 625-4001
Contract Pharmacy Representative
Kroger
Anastasia Frey, Senior Manager, Payor Contracting
(513) 698-1875
Signed By Date
1/15/2019
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session