Contract Pharmacy Details

PRESTON DRUG INC
CH100180 HEALTH WEST INC

Covered Entity Details

Entity Name

HEALTH WEST INC

Subdivision Name

HEALTH WEST - ADMINISTRATION OFFICES

Type

HRSA-Funded Health Center

340B ID

CH100180

Entity Address

500 S 11th AVE
POCATELLO, ID 83201-4835

Grant Number

H80CS00321

Participating Start Date

4/1/2004

Last Recertification Date

2/12/2025

Pharmacy Details

Pharmacy Name

PRESTON DRUG INC

Pharmacy Address

39 N 1ST E
PRESTON, ID 83263-1325

Pharmacy Comments

Contract Details

Approval Date

9/27/2023

Contract Begin Date

10/1/2023

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Mindy Benedetti, CEO
(208) 232-7862 Ext: 1120

Contract Pharmacy Representative

PRESTON DRUG INC
SETH HASLAM, OWNER
(208) 852-1563

Signed By Date

9/27/2023