Contract Pharmacy Details

SHOPKO PHARMACY #2095
CHC26601-00 Full Circle Health, Inc.

Covered Entity Details

Entity Name

Full Circle Health, Inc.

Subdivision Name

Full Circle Health - Meridian

Type

HRSA-Funded Health Center

340B ID

CHC26601-00

Entity Address

2275 S Eagle Rd STE 120
Meridian, ID 83642-2620

Grant Number

H80CS26601

Participating Start Date

4/1/2014

Last Recertification Date

2/13/2025

Pharmacy Details

Pharmacy Name

SHOPKO PHARMACY #2095

Pharmacy Address

2655 SOUTH BROADWAY AVE
BOISE, ID 83706

Pharmacy Comments

Contract Details

Approval Date

1/17/2017

Contract Begin Date

4/1/2017

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

1/11/2019
Pharmacy closed

Contacts

Covered Entity Signing Official

Ted Epperly, President and CEO
(208) 954-8745

Contract Pharmacy Representative

ShopKo
Lorie Neumann, Contracting & Compliance
(920) 429-4726

Signed By Date

1/17/2017

340B Drug Pricing Program Database