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NORTHWEST PHARMACY
CAH131327-00 Gritman Medical Center
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Covered Entity Details
Entity Name
Gritman Medical Center
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH131327-00
Entity Address
700 S Main St
Moscow, ID 83843
Medicare Provider Number
131327
Participating Start Date
7/1/2013
Last Recertification Date
8/28/2024
Pharmacy Details
Pharmacy Name
NORTHWEST PHARMACY
Pharmacy Address
210 6TH ST
POTLATCH, ID 83855
Pharmacy Comments
Contract Details
Approval Date
4/27/2016
Contract Begin Date
7/1/2016
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Kara Besst, CEO
(208) 883-2220
Contract Pharmacy Representative
William Edwards, Owner/Pharmacist
(208) 875-1212
Signed By Date
4/27/2016
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