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WAL-MART PHARMACY 10-2485
CH10630L BOUNDARY REGIONAL COMMUNITY HEALTH CENTER, INC
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Covered Entity Details
Entity Name
BOUNDARY REGIONAL COMMUNITY HEALTH CENTER, INC
Subdivision Name
Kaniksu CCBHC
Type
HRSA-Funded Health Center
340B ID
CH10630L
Entity Address
1033 Baldy Mountain Rd
Sandpoint, ID 83864-9202
Grant Number
H80CS00302
Participating Start Date
7/1/2025
Last Recertification Date
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-2485
Pharmacy Address
476999 HWY 95 NORTH
PONDERAY, ID 83852
Pharmacy Comments
Contract Details
Approval Date
4/24/2025
Contract Begin Date
7/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Emma Keverkamp, Chief Financial Officer
(208) 263-7101 Ext: 2213
Contract Pharmacy Representative
Wal-Mart
marcus osborne, vp 340Bprogram
(714) 141-2414
Signed By Date
4/14/2025
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