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ARNZEN 'S KAMIAH DRUG
CAH131321-00 ST. MARYS HOSPITAL
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Covered Entity Details
Entity Name
ST. MARYS HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH131321-00
Entity Address
701 LEWISTON ST.
COTTONWOOD, ID 83522-0137
Medicare Provider Number
131321
Participating Start Date
4/1/2019
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
ARNZEN 'S KAMIAH DRUG
Pharmacy Address
318 MAIN STREET
PO BOX 787
KAMIAH, ID 83536
Pharmacy Comments
Contract Details
Approval Date
4/14/2021
Contract Begin Date
7/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jyl Ruland, CFO
(208) 476-8062
Contract Pharmacy Representative
Arnzen Super Drug Inc.
Rod F. Arnzen, Owner
(208) 935-2301
Signed By Date
4/14/2021
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