Contract Pharmacy Details

KWIK-MEDS
CAH131319-00 Minidoka Memorial Hospital

Covered Entity Details

Entity Name

Minidoka Memorial Hospital

Subdivision Name

Type

Critical Access Hospital

340B ID

CAH131319-00

Entity Address

1224 8th St
Rupert, ID 83350

Medicare Provider Number

131319

Participating Start Date

7/1/2012

Last Recertification Date

8/21/2024

Pharmacy Details

Pharmacy Name

KWIK-MEDS

Pharmacy Address

K2RED LLC
256 OVERLAND AVE
BURLEY, ID 83318-1023

Pharmacy Comments

Contract Details

Approval Date

1/15/2020

Contract Begin Date

4/1/2020

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Jason Gibbons, CFO
(208) 436-8153

Contract Pharmacy Representative

K2RED LLC
Daniel Fuchs, Member
(208) 878-6337

Signed By Date

1/15/2020