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FRED MEYER PHARMACY #685
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
FRED MEYER PHARMACY #685
Pharmacy Address
1400 WEST CHINDEN BLVD
MERIDIAN, ID 83646
Pharmacy Comments
Contract Details
Approval Date
1/17/2017
Contract Begin Date
4/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Ted Epperly, President and CEO
(208) 954-8745
Contract Pharmacy Representative
Kroger
Mike Puccini, New Business Development Manager
(513) 762-4672
Signed By Date
1/17/2017
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