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ALBERTSONS LLC
CAH131318-00 WALTER KNOX MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
WALTER KNOX MEMORIAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH131318-00
Entity Address
1202 EAST LOCUST
EMMETT, ID 83617
Medicare Provider Number
131318
Participating Start Date
10/1/2016
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
ALBERTSONS LLC
Pharmacy Address
SAV-ON PHARMACY #126
640 HIGHWAY 16
EMMETT, ID 83617
Pharmacy Comments
Contract Details
Approval Date
7/15/2016
Contract Begin Date
10/1/2016
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Nathan Coburn, CFO
(208) 901-3213
Contract Pharmacy Representative
Albertsons
Ronald Richmon, Group Director of Managed Care
(630) 948-6285
Signed By Date
7/15/2016
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