Contract Pharmacy Details

WALGREEN CO.
CAH131325-00 BMH, INC. DBA BINGHAM MEMORIAL HOSPITAL

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

WALGREEN CO.

Pharmacy Address

DBA: WALGREENS #13672
960 WEST BRIDGE STREET
BLACKFOOT, ID 83221

Pharmacy Comments

Contract Details

Approval Date

3/7/2013

Contract Begin Date

4/1/2013

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

10/27/2023
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

JEFFERY D. DANIELS, CEO
(208) 785-3803

Contract Pharmacy Representative

Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663

Signed By Date

1/4/2013

340B Drug Pricing Program Database