Contract Pharmacy Details

IDAHO CVS PHARMACY, L.L.C.
CHC26601-00 Full Circle Health, Inc.

Covered Entity Details

Entity Name

Full Circle Health, Inc.

Subdivision Name

Full Circle Health - Meridian

Type

HRSA-Funded Health Center

340B ID

CHC26601-00

Entity Address

2275 S Eagle Rd STE 120
Meridian, ID 83642-2620

Grant Number

H80CS26601

Participating Start Date

4/1/2014

Last Recertification Date

2/13/2025

Pharmacy Details

Pharmacy Name

IDAHO CVS PHARMACY, L.L.C.

Pharmacy Address

CVS/PHARMACY # 11169
7402 WEST FAIRVIEW AVE
BOISE, ID 83704

Pharmacy Comments

Contract Details

Approval Date

1/4/2023

Contract Begin Date

4/1/2023

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Tad Arnt, Chief Operating Officer
(208) 514-2500 Ext: 1104

Contract Pharmacy Representative

CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782

Signed By Date

1/4/2023

340B Drug Pricing Program Database