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ROCKLAND PHARMACY
CH100180 HEALTH WEST INC
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Covered Entity Details
Entity Name
HEALTH WEST INC
Subdivision Name
HEALTH WEST - ADMINISTRATION OFFICES
Type
HRSA-Funded Health Center
340B ID
CH100180
Entity Address
500 S 11th AVE
POCATELLO, ID 83201-4835
Grant Number
H80CS00321
Participating Start Date
4/1/2004
Last Recertification Date
2/12/2025
Pharmacy Details
Pharmacy Name
ROCKLAND PHARMACY
Pharmacy Address
524 TYHEE AVE
AMERICAN FALLS, ID 83211-8321
Pharmacy Comments
Contract Details
Approval Date
4/24/2019
Contract Begin Date
4/24/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Mindy Benedetti, CEO
(208) 232-7862 Ext: 1120
Contract Pharmacy Representative
Rockland Pharmacy
P. Scott Anderson, Owner
(208) 226-2411
Signed By Date
4/24/2019
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