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RIDLEY'S FOOD CORP
CAH131326-00 IHC Health Services Inc. DBA Intermountain Health Cassia Regional Hospital
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Covered Entity Details
Entity Name
IHC Health Services Inc. DBA Intermountain Health Cassia Regional Hospital
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH131326-00
Entity Address
1501 Hiland Avenue
Burley, ID 83318
Medicare Provider Number
131326
Participating Start Date
4/1/2013
Last Recertification Date
8/14/2024
Pharmacy Details
Pharmacy Name
RIDLEY'S FOOD CORP
Pharmacy Address
310 ONEIDA ST
RUPERT, ID 83350-1756
Pharmacy Comments
Contract Details
Approval Date
3/15/2013
Contract Begin Date
4/1/2013
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/28/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Rod Barton, Administrator
(208) 677-6440
Contract Pharmacy Representative
Ridley's Food Corp
Todd Wise, Pharmacy Coordinator
(801) 358-3365
Signed By Date
3/15/2013
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