Contract Pharmacy Details

WAL-MART PHARMACY 10-3472
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 10-3472

Pharmacy Address

3050 EAST MULLAN AVENUE
POST FALLS, ID 83854

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

Wal-Mart
Marcus Osborne, V.P. Health & Wellness, Sales & Contracting
(479) 204-9374

Signed By Date

340B Drug Pricing Program Database