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WAL-MART PHARMACY 10-2780
RRC130013-00 ST. ALPHONSUS MEDICAL CENTER - NAMP
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Covered Entity Details
Entity Name
ST. ALPHONSUS MEDICAL CENTER - NAMP
Subdivision Name
Type
Rural Referral Center
340B ID
RRC130013-00
Entity Address
4300 East Flamingo Ave
NAMPA, ID 83687
Medicare Provider Number
130013
Participating Start Date
4/1/2025
Last Recertification Date
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-2780
Pharmacy Address
5108 EAST CLEVELAND BLVD
CALDWELL, ID 83607
Pharmacy Comments
Contract Details
Approval Date
2/28/2025
Contract Begin Date
4/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Lannie Checketts, RHM CFO Idaho Oregon Region
(208) 367-7347
Contract Pharmacy Representative
Walmart
Julie Howard, 340b Program Manager
(479) 739-1973 Ext: 4792771498
Signed By Date
1/13/2025
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