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GOODING PHARMACY
CH101650 FAMILY HEALTH SERVICES CORPORATION
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Covered Entity Details
Entity Name
FAMILY HEALTH SERVICES CORPORATION
Subdivision Name
FAMILY HEALTH SERVICES - ADMINISTRATION
Type
HRSA-Funded Health Center
340B ID
CH101650
Entity Address
794 Eastland Dr
Twin Falls, ID 83301-6856
Grant Number
H80CS00425
Participating Start Date
1/1/2004
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
GOODING PHARMACY
Pharmacy Address
DBA: SHOSHONE PHARMACY
653 SOUTH BEVERLY STREET
SHOSHONE, ID 83352
Pharmacy Comments
Contract Details
Approval Date
4/15/2022
Contract Begin Date
7/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Aaron J Houston, CEO
(208) 734-3312 Ext: 6708
Contract Pharmacy Representative
R AND R PHARMACY
JASON READING, PRESIDENT
(208) 324-3784
Signed By Date
4/15/2022
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