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WAL-MART PHARMACY 10-2485
CAH131301-00 BOUNDARY COMMUNITY HOSPITAL
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Covered Entity Details
Entity Name
BOUNDARY COMMUNITY HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH131301-00
Entity Address
6640 KANIKSU
BONNERS FERRY, ID 83805
Medicare Provider Number
131301
Participating Start Date
1/1/2023
Last Recertification Date
8/14/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-2485
Pharmacy Address
476999 HWY 95 NORTH
PONDERAY, ID 83852
Pharmacy Comments
Contract Details
Approval Date
7/11/2023
Contract Begin Date
10/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
April Bennett, CEO
(208) 267-4850
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
7/11/2023
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