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WALGREEN CO.
CH100180 HEALTH WEST INC
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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
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 09092
70 GATEWAY BLVD
ROCK SPRINGS, WY 82901-5709
Pharmacy Comments
Contract Details
Approval Date
7/8/2024
Contract Begin Date
10/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Mark T Horrocks, Chief Medical Officer
(208) 232-7862
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/8/2024
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