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WALGREEN CO.
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
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 01221
3212 E CHINDEN BLVD
EAGLE, ID 83616
Pharmacy Comments
Contract Details
Approval Date
1/17/2017
Contract Begin Date
4/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
3/29/2017
Pharmacy closed
Contacts
Covered Entity Signing Official
Nathan Coburn, CFO
(208) 901-3213
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
1/17/2017
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