Contract Pharmacy Details

THRIFTY PAYLESS, INC.
RRC130049-00 KOOTENAI HEALTH INC

Covered Entity Details

Entity Name

KOOTENAI HEALTH INC

Subdivision Name

Type

Rural Referral Center

340B ID

RRC130049-00

Entity Address

2003 KOOTENAI HEALTH WAY
COEUR DALENE, ID 83814

Medicare Provider Number

130049

Participating Start Date

7/1/2025

Last Recertification Date

Pharmacy Details

Pharmacy Name

THRIFTY PAYLESS, INC.

Pharmacy Address

RITE AID #6200
43 WEST PRAIRIE SHOPPING CTR
HAYDEN, ID 83835

Pharmacy Comments

Contract Details

Approval Date

4/28/2025

Contract Begin Date

7/1/2025

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Michele Bouit, CFO
(208) 625-4004

Contract Pharmacy Representative

Rite Aid
Owen McMahon, GVP, Enterprise Pharmaceutical Purchasing
(717) 214-2505

Signed By Date

4/14/2025

340B Drug Pricing Program Database