340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
JACKS PHARMACY 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
4/1/2019
Last Recertification Date
8/18/2020
Entity Termination Date
7/1/2021
Pharmacy Details
Pharmacy Name
JACKS PHARMACY INC
Pharmacy Address
103 E COLLEGE AVE
ST MARIES, ID 83861
Pharmacy Comments
Contract Details
Approval Date
7/9/2020
Contract Begin Date
10/1/2020
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
Jacks Pharmacy Inc
Colt Darley, President
(208) 245-4578
Signed By Date
7/9/2020
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