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WALGREEN CO.
CAH131327-00 Gritman Medical Center
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Covered Entity Details
Entity Name
Gritman Medical Center
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH131327-00
Entity Address
700 S Main St
Moscow, ID 83843
Medicare Provider Number
131327
Participating Start Date
7/1/2013
Last Recertification Date
8/28/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 02679
2102 NEZ PERCE DR
LEWISTON, ID 83501
Pharmacy Comments
Contract Details
Approval Date
10/14/2020
Contract Begin Date
1/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Kara Besst, CEO
(208) 883-2220
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/14/2020
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