Contract Pharmacy Details

ALLEN DRUG
CAH131303-00 ONEIDA COUNTY HOSPITAL

Covered Entity Details

Entity Name

ONEIDA COUNTY HOSPITAL

Subdivision Name

Type

Critical Access Hospital

340B ID

CAH131303-00

Entity Address

150 NORTH 200 WEST
MALAD CITY, ID 83252-0126

Medicare Provider Number

131303

Participating Start Date

9/28/2010

Last Recertification Date

9/6/2024

Pharmacy Details

Pharmacy Name

ALLEN DRUG

Pharmacy Address

4 N MAIN ST
MALAD CITY, ID 83252-4913

Pharmacy Comments

Contract Details

Approval Date

1/14/2015

Contract Begin Date

4/1/2015

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

John Williams, ADMINISTRATOR / CEO
(208) 766-2231

Contract Pharmacy Representative

Richard Allen, Owner
(208) 766-2241

Signed By Date

1/14/2015