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LARRY'S FAMILY PHARMACY
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
LARRY'S FAMILY PHARMACY
Pharmacy Address
LARRY'S FAMILY PHARMACY
217 S STATE ST
PRESTON, ID 83263
Pharmacy Comments
Contract Details
Approval Date
1/16/2017
Contract Begin Date
4/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Mindy Benedetti, CEO
(208) 232-7862 Ext: 1120
Contract Pharmacy Representative
Larry Stokes, Owner
(208) 852-0163
Signed By Date
1/16/2017
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