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RIDLEY'S GLENNS FERRY PHARMACY
CH101610 GLENNS FERRY HEALTH CENTER, Inc.
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Covered Entity Details
Entity Name
GLENNS FERRY HEALTH CENTER, Inc.
Subdivision Name
DESERT SAGE HEALTH CENTERS
Type
HRSA-Funded Health Center
340B ID
CH101610
Entity Address
486 W. FIRST AVE.
GLENNS FERRY, ID 83623
Grant Number
H80CS00473
Participating Start Date
10/1/1998
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
RIDLEY'S GLENNS FERRY PHARMACY
Pharmacy Address
LIMITED SERVICE LICENSE
486 W 1ST AVE # 473
GLENNS FERRY, ID 83623
Pharmacy Comments
Contract Details
Approval Date
7/15/2019
Contract Begin Date
10/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Mary Ferguson, CEO
(208) 366-7416
Contract Pharmacy Representative
Ridley's Food Corp
Todd Wise, Pharmacy Coordinator
(801) 358-3365
Signed By Date
7/15/2019
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