Contract Pharmacy Details

WHEELER'S PHARMACY
CAH131308-00 CASCADE MEDICAL CENTER

Covered Entity Details

Entity Name

CASCADE MEDICAL CENTER

Subdivision Name

Type

Critical Access Hospital

340B ID

CAH131308-00

Entity Address

402 Lake Cascade Parkway
CASCADE, ID 83611-0151

Medicare Provider Number

131308

Participating Start Date

4/1/2018

Last Recertification Date

8/15/2024

Pharmacy Details

Pharmacy Name

WHEELER'S PHARMACY

Pharmacy Address

104 N MAIN
P.O. BOX 797
CASCADE, ID 83611

Pharmacy Comments

Contract Details

Approval Date

10/13/2014

Contract Begin Date

1/1/2015

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

1/1/2018
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Virgil Boss, CEO
(208) 382-4282

Contract Pharmacy Representative

Amanda Boxleitner, pharmacist
(208) 382-4204

Signed By Date

10/13/2014