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SNELL'S PHARMACY SHOP
FQHC638535A Shoshone-Bannock Tribes Health & Human Services Community Health Center
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Covered Entity Details
Entity Name
Shoshone-Bannock Tribes Health & Human Services Community Health Center
Subdivision Name
Type
Tribal Contract/Compact with IHS (P.L. 93-638)
340B ID
FQHC638535A
Entity Address
70 Navajo Drive
Fort Hall, ID 83203
Grant Number
Participating Start Date
1/1/2016
Last Recertification Date
2/23/2017
Entity Termination Date
4/1/2017
Pharmacy Details
Pharmacy Name
SNELL'S PHARMACY SHOP
Pharmacy Address
ED SNELL'S PHARMACY SHOP
1015 E YOUNG ST
POCATELLO, ID 83201-8320
Pharmacy Comments
Contract Details
Approval Date
11/2/2015
Contract Begin Date
1/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2017
Contacts
Covered Entity Signing Official
Steve Hagler, Tribal CFO
(208) 478-3843
Contract Pharmacy Representative
Ed Snell, Pharmacist/Owner
(208) 232-0049
Signed By Date
11/2/2015
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