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ALLEN DRUG
CH100180 HEALTH WEST INC
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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
ALLEN DRUG
Pharmacy Address
4 N MAIN ST
MALAD CITY, ID 83252-4913
Pharmacy Comments
Contract Details
Approval Date
4/15/2014
Contract Begin Date
7/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/26/2017
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Elizabeth Mahoney, CEO
(208) 232-7862 Ext: 1107
Contract Pharmacy Representative
Richard Allen, Owner
(208) 766-2241
Signed By Date
4/15/2014
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