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WALGREEN CO
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
WALGREEN CO
Pharmacy Address
DBA: WALGREENS
17500 PERRIS BLVD
MORENO VALLEY, CA 92551-9547
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
8/12/2015
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
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