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WALGREEN CO
DSH130013 Saint Alphonsus Medical Center Nampa
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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 #12123
3395 S. FEDERAL WAY
BOISE, ID 83705
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
2/27/2024
Pharmacy closed
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
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