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OPTION CARE ENTERPRISES, INC.
CAH131328-00 Bonner General Hospital
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Covered Entity Details
Entity Name
Bonner General Hospital
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH131328-00
Entity Address
520 North 3rd Avenue
Sandpoint, ID 83864
Medicare Provider Number
131328
Participating Start Date
4/1/2014
Last Recertification Date
8/12/2024
Pharmacy Details
Pharmacy Name
OPTION CARE ENTERPRISES, INC.
Pharmacy Address
D/B/A OPTION CARE
11403 BLUEGRASS PARKWAY
SUITE 400
LOUISVILLE, KY 40299-2398
Pharmacy Comments
Contract Details
Approval Date
10/13/2016
Contract Begin Date
1/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/12/2018
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Sheryl Rickard, Chief Executive Officer
(208) 263-1441 Ext: 1100
Contract Pharmacy Representative
Option Care
David Schulta, General Manager
(502) 266-0123
Signed By Date
10/13/2016
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