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WALGREEN CO.
DSH130071 St. Luke's Nampa Medical Center
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Covered Entity Details
Entity Name
St. Luke's Nampa Medical Center
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH130071
Entity Address
9850 W ST LUKES DRIVE
Nampa, ID 83687
Medicare Provider Number
130071
Participating Start Date
7/1/2019
Last Recertification Date
8/27/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 01972
6725 N GLENWOOD ST
BOISE, ID 83714
Pharmacy Comments
Contract Details
Approval Date
1/6/2022
Contract Begin Date
4/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Peter DiDio, Vice President, Controller
(208) 381-1251
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
1/6/2022
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