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WAL-MART PHARMACY 10-1995
CHC26601-00 Full Circle Health, Inc.
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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
WAL-MART PHARMACY 10-1995
Pharmacy Address
4240 YELLOWSTONE AVENUE
CHUBBUCK, ID 83202
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
11/17/2018
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Ted Epperly, President and CEO
(208) 954-8745
Contract Pharmacy Representative
Walmart
Julie Howard, 340B Program Manager
(479) 277-1498
Signed By Date
1/17/2017
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