340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
MEDICINE MAN PRAIRIE PHARMACY
CH108170 Dirne Health Centers, Inc.
Print
Covered Entity Details
Entity Name
Dirne Health Centers, Inc.
Subdivision Name
Heritage Health CDA
Type
HRSA-Funded Health Center
340B ID
CH108170
Entity Address
1090 W Park Pl
Coeur D Alene, ID 83814-2785
Grant Number
H80CS02331
Participating Start Date
4/1/2004
Last Recertification Date
3/5/2025
Pharmacy Details
Pharmacy Name
MEDICINE MAN PRAIRIE PHARMACY
Pharmacy Address
8093 N CORNERSTONE DR
MEDICINE MAN PRAIRIE PHARMACY
HAYDEN, ID 83835
Pharmacy Comments
Contract Details
Approval Date
10/8/2024
Contract Begin Date
1/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Michael Baker, CEO
(208) 292-0256
Contract Pharmacy Representative
Medicine Man North Pharmacy Inc
Korey Kreider, Pharmacy Owner
(208) 762-9355
Signed By Date
10/8/2024
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session