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WAL-MART PHARMACY 10-1902
CAH131325-00 BMH, INC. DBA BINGHAM MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
BMH, INC. DBA BINGHAM MEMORIAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH131325-00
Entity Address
98 POPLAR
BLACKFOOT, ID 83221
Medicare Provider Number
131325
Participating Start Date
9/8/2010
Last Recertification Date
8/14/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-1902
Pharmacy Address
1201 SOUTH 25TH EAST
AMMON, ID 83406
Pharmacy Comments
Contract Details
Approval Date
7/20/2021
Contract Begin Date
10/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
2/1/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Jake Erickson, CEO
(208) 785-3803
Contract Pharmacy Representative
Walmart
Julie Howard, 340B Program Manager
(479) 277-1498
Signed By Date
7/20/2021
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