340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
KOHAL PHARMACY INCORPORATED
DSH130049 KOOTENAI HEALTH INC
Print
Covered Entity Details
Entity Name
KOOTENAI HEALTH INC
Subdivision Name
KOOTENAI HEALTH
Type
Disproportionate Share Hospital
340B ID
DSH130049
Entity Address
2003 Kootenai Health Way
COEUR DALENE, ID 83814
Medicare Provider Number
130049
Participating Start Date
7/1/2021
Last Recertification Date
8/20/2024
Entity Termination Date
7/1/2025
Pharmacy Details
Pharmacy Name
KOHAL PHARMACY INCORPORATED
Pharmacy Address
KOHAL PHARMACY, INC.
740 MCKINLEY AVE
KELLOGG, ID 83837-2693
Pharmacy Comments
Contract Details
Approval Date
4/11/2023
Contract Begin Date
5/10/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/26/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Michele Bouit, CFO
(208) 625-4004
Contract Pharmacy Representative
Kohal Pharmacy
Tony Wright, Owner
(208) 786-9303
Signed By Date
4/11/2023
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session