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BROULIM'S PHARMACY
CAH131309-00 CARIBOU MEDICAL CENTER
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Covered Entity Details
Entity Name
CARIBOU MEDICAL CENTER
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH131309-00
Entity Address
300 SOUTH 3RD WEST
SODA SPRINGS, ID 83276
Medicare Provider Number
131309
Participating Start Date
4/1/2011
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
BROULIM'S PHARMACY
Pharmacy Address
89 W 2ND S
SODA SPRINGS, ID 83276-1509
Pharmacy Comments
Contract Details
Approval Date
4/19/2013
Contract Begin Date
7/1/2013
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
JOHN HOOPES, CEO
(208) 547-2780
Contract Pharmacy Representative
Neil Hurley, Pharmacist
(208) 356-5416
Signed By Date
4/19/2013
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