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HOLLIS FAMILY PHARMACY LLC
CAH131318-00 WALTER KNOX MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
WALTER KNOX MEMORIAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH131318-00
Entity Address
1202 EAST LOCUST
EMMETT, ID 83617
Medicare Provider Number
131318
Participating Start Date
10/1/2016
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
HOLLIS FAMILY PHARMACY LLC
Pharmacy Address
845 S SUB STATION RD
EMMETT, ID 83617-9430
Pharmacy Comments
Contract Details
Approval Date
7/15/2022
Contract Begin Date
10/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Brad Turpen, CEO
(208) 999-3870
Contract Pharmacy Representative
Hollis Family Pharmacy
Anthony hollis, Owner
(208) 369-4510
Signed By Date
7/15/2022
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