Contract Pharmacy Details

BENGAL PHARMACY
CH100180 HEALTH WEST INC

Covered Entity Details

Entity Name

HEALTH WEST INC

Subdivision Name

HEALTH WEST - ADMINISTRATION OFFICES

Type

HRSA-Funded Health Center

340B ID

CH100180

Entity Address

500 S 11th AVE
POCATELLO, ID 83201-4835

Grant Number

H80CS00321

Participating Start Date

4/1/2004

Last Recertification Date

2/12/2025

Pharmacy Details

Pharmacy Name

BENGAL PHARMACY

Pharmacy Address

990 SOUTH 8TH AVE
POCATELLO, ID 83209-0001

Pharmacy Comments

Contract Details

Approval Date

1/9/2014

Contract Begin Date

4/1/2014

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

6/30/2021
Ownership change

Contacts

Covered Entity Signing Official

Elizabeth Mahoney, CEO
(208) 232-7862 Ext: 1107

Contract Pharmacy Representative

Rebecca Hoover, Director of Pharmacy
(208) 282-6064

Signed By Date

1/9/2014