Contract Pharmacy Details

BENGAL PHARMACY
CHC29003-00 NORTH CUSTER HOSPITAL DIS

Covered Entity Details

Entity Name

NORTH CUSTER HOSPITAL DIS

Subdivision Name

Challis Area Health Center

Type

HRSA-Funded Health Center

340B ID

CHC29003-00

Entity Address

611 CLINIC RD
CHALLIS, ID 83226-4824

Grant Number

H80CS29003

Participating Start Date

4/1/2016

Last Recertification Date

2/10/2025

Pharmacy Details

Pharmacy Name

BENGAL PHARMACY

Pharmacy Address

990 SOUTH 8TH AVE
POCATELLO, ID 83209-0001

Pharmacy Comments

Contract Details

Approval Date

1/19/2016

Contract Begin Date

4/1/2016

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

7/1/2021
Ownership change

Contacts

Covered Entity Signing Official

Kate Taylor, Administrator
(208) 879-4351 Ext: 1

Contract Pharmacy Representative

Kerry Casperson, President
(208) 282-3407

Signed By Date

1/19/2016