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IDAHO CVS PHARMACY, L.L.C.
CAH131326-00 IHC Health Services Inc. DBA Intermountain Health Cassia Regional Hospital
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Covered Entity Details
Entity Name
IHC Health Services Inc. DBA Intermountain Health Cassia Regional Hospital
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH131326-00
Entity Address
1501 Hiland Avenue
Burley, ID 83318
Medicare Provider Number
131326
Participating Start Date
4/1/2013
Last Recertification Date
8/14/2024
Pharmacy Details
Pharmacy Name
IDAHO CVS PHARMACY, L.L.C.
Pharmacy Address
CVS PHARMACY # 16216
1611 BLUE LAKES BLVD N
TWIN FALLS, ID 83301
Pharmacy Comments
Contract Details
Approval Date
10/4/2021
Contract Begin Date
1/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Ben Smalley, Administrator
(208) 677-6441
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
10/4/2021
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