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MEDICINE MAN BONNERS FERRY PHARMACY
CH106300 BOUNDARY REGIONAL COMMUNITY HEALTH CENTER, INC.
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Covered Entity Details
Entity Name
BOUNDARY REGIONAL COMMUNITY HEALTH CENTER, INC.
Subdivision Name
BOUNDARY REGIONAL CHC
Type
HRSA-Funded Health Center
340B ID
CH106300
Entity Address
6615 COMANCHE ST
BONNERS FERRY, ID 83805
Grant Number
H80CS00302
Participating Start Date
10/1/2004
Last Recertification Date
2/12/2025
Pharmacy Details
Pharmacy Name
MEDICINE MAN BONNERS FERRY PHARMACY
Pharmacy Address
6452 MAIN STREET
BONNERS FERRY, ID 83805
Pharmacy Comments
Contract Details
Approval Date
10/14/2015
Contract Begin Date
1/1/2016
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
VICTORIA McCLELLAN KING, CEO
(208) 263-7101 Ext: 2202
Contract Pharmacy Representative
Aimee Stuermer, Owner
(208) 267-4024
Signed By Date
10/14/2015
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