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RIDLEY'S GLENNS FERRY PHARMACY
CH10161B GLENNS FERRY HEALTH CENTER, INC.
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Covered Entity Details
Entity Name
GLENNS FERRY HEALTH CENTER, INC.
Subdivision Name
DESERT SAGE HEALTH CENTERS
Type
HRSA-Funded Health Center
340B ID
CH10161B
Entity Address
350 Main Street
GRAND VIEW, ID 83624
Grant Number
H80CS00473
Participating Start Date
4/1/2017
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
RIDLEY'S GLENNS FERRY PHARMACY
Pharmacy Address
LIMITED SERVICE LICENSE
486 W 1ST AVE # 473
GLENNS FERRY, ID 83623
Pharmacy Comments
Contract Details
Approval Date
10/13/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Mary Ferguson Ferguson, CEO
(208) 696-7216
Contract Pharmacy Representative
Ridley's Food Corp
Todd Wise, Pharmacy Coordinator
(801) 358-3365
Signed By Date
10/13/2023
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