Contract Pharmacy Details

WAL-MART PHARMACY 10-3511
CH10817J DIRNE HEALTH CENTERS, INC.

Covered Entity Details

Entity Name

DIRNE HEALTH CENTERS, INC.

Subdivision Name

Dirne CHC Physical Therapy

Type

HRSA-Funded Health Center

340B ID

CH10817J

Entity Address

610 W Hubbard St
Coeur D Alene, ID 83814-2285

Grant Number

H80CS02331

Participating Start Date

1/1/2015

Last Recertification Date

2/12/2015

Entity Termination Date

1/1/2016

Pharmacy Details

Pharmacy Name

WAL-MART PHARMACY 10-3511

Pharmacy Address

550 W. HONEYSUCKLE AVE.
HAYDEN, ID 83835

Pharmacy Comments

Contract Details

Approval Date

10/23/2014

Contract Begin Date

1/1/2015

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

1/1/2016

Contacts

Covered Entity Signing Official

Contract Pharmacy Representative

Healdsburg District Hospital
Kathi Phelps, Manager Contracting
(479) 277-3719

Signed By Date

340B Drug Pricing Program Database