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Walgreens #21435
CAH131318-00 WALTER KNOX MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
WALTER KNOX MEMORIAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH131318-00
Entity Address
1202 EAST LOCUST
EMMETT, ID 83617
Medicare Provider Number
131318
Participating Start Date
10/1/2016
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
Walgreens #21435
Pharmacy Address
Walgreens Central Fill #21435
6306 S Airport Rd
West Jordan, UT 84084-5601
Pharmacy Comments
Contract Details
Approval Date
1/12/2024
Contract Begin Date
4/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Brad Turpen, CEO
(208) 999-3870
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
1/12/2024
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