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WALGREEN CO.
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
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS #13673
904 E MAIN ST
BURLEY, ID 83318
Pharmacy Comments
Contract Details
Approval Date
10/17/2016
Contract Begin Date
1/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Rod Barton, Administrator
(208) 677-6440
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/17/2016
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