Contract Pharmacy Details

PROCARE PHARMACY, L.L.C.
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

PROCARE PHARMACY, L.L.C.

Pharmacy Address

DBA CVS/PHARMACY #2926
1001 MADISON ST.
SEATTLE, WA 98104

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

CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782

Signed By Date

4/14/2025

340B Drug Pricing Program Database