Contract Pharmacy Details

WALGREEN CO.
DSH130013 Saint Alphonsus Medical Center Nampa

Covered Entity Details

Entity Name

Saint Alphonsus Medical Center Nampa

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH130013

Entity Address

4300 East Flamingo Ave
NAMPA, ID 83687

Medicare Provider Number

130013

Participating Start Date

10/17/2005

Last Recertification Date

8/20/2024

Entity Termination Date

1/1/2025

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

DBA: WALGREENS #11687
4850 N LINDER RD
MERIDIAN, ID 83646

Pharmacy Comments

Contract Details

Approval Date

10/27/2014

Contract Begin Date

1/1/2015

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

1/1/2025
Covered Entity Terminated

Contacts

Covered Entity Signing Official

KARL KEELER, CEO
(208) 463-5398

Contract Pharmacy Representative

Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663

Signed By Date

10/27/2014

340B Drug Pricing Program Database