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DICK'S PHARMACY
CH101650 FAMILY HEALTH SERVICES CORPORATION
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Covered Entity Details
Entity Name
FAMILY HEALTH SERVICES CORPORATION
Subdivision Name
FAMILY HEALTH SERVICES - ADMINISTRATION
Type
HRSA-Funded Health Center
340B ID
CH101650
Entity Address
794 Eastland Dr
Twin Falls, ID 83301-6856
Grant Number
H80CS00425
Participating Start Date
1/1/2004
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
DICK'S PHARMACY
Pharmacy Address
K2RED LLC
526 SHOUP AVE W
STE K
TWIN FALLS, ID 83301
Pharmacy Comments
Contract Details
Approval Date
10/12/2011
Contract Begin Date
10/17/2011
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Yolanda Cabello, Director of Nursing
(208) 734-3312 Ext: 6716
Contract Pharmacy Representative
K2RED LLC
Daniel Fuchs, Member
(208) 878-6337
Signed By Date
10/10/2011
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