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MEDICINE MAN RATHDRUM
CH108170 Dirne Health Centers, Inc.
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Covered Entity Details
Entity Name
Dirne Health Centers, Inc.
Subdivision Name
Heritage Health CDA
Type
HRSA-Funded Health Center
340B ID
CH108170
Entity Address
1090 W Park Pl
Coeur D Alene, ID 83814-2785
Grant Number
H80CS02331
Participating Start Date
4/1/2004
Last Recertification Date
3/5/2025
Pharmacy Details
Pharmacy Name
MEDICINE MAN RATHDRUM
Pharmacy Address
15837 N WESTWOOD DR
RATHDRUM, ID 83858-6432
Pharmacy Comments
Contract Details
Approval Date
10/9/2013
Contract Begin Date
1/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
8/19/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Michael Baker, CEO
(208) 292-0256
Contract Pharmacy Representative
Medicine Man West
Aimee Donald Smith Stuerner, Pharmacist
(208) 267-4021
Signed By Date
10/9/2013
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