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WAL-MART PHARMACY 10-1905
CAH131325-00 BMH, INC. DBA BINGHAM MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
BMH, INC. DBA BINGHAM MEMORIAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH131325-00
Entity Address
98 POPLAR
BLACKFOOT, ID 83221
Medicare Provider Number
131325
Participating Start Date
9/8/2010
Last Recertification Date
8/14/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-1905
Pharmacy Address
565 JENSEN GROVE DRIVE
BLACKFOOT, ID 83221
Pharmacy Comments
Contract Details
Approval Date
12/3/2012
Contract Begin Date
12/3/2012
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
JEFFERY D. DANIELS, CEO
(208) 785-3803
Contract Pharmacy Representative
Wal-Mart
Marcus Osborne, V.P. Health & Wellness, Sales & Contracting
(479) 204-9374
Signed By Date
9/28/2012
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