Contract Pharmacy Details

SHOPKO PHARMACY #2069
CH108170 Dirne Health Centers, Inc.

Covered Entity Details

Entity Name

Dirne Health Centers, Inc.

Subdivision Name

Heritage Health CDA

Type

HRSA-Funded Health Center

340B ID

CH108170

Entity Address

1090 W Park Pl
Coeur D Alene, ID 83814-2785

Grant Number

H80CS02331

Participating Start Date

4/1/2004

Last Recertification Date

3/5/2025

Pharmacy Details

Pharmacy Name

SHOPKO PHARMACY #2069

Pharmacy Address

217 WEST IRONWOOD DRIVE
COEUR D'ALENE, ID 83814

Pharmacy Comments

Contract Details

Approval Date

10/4/2017

Contract Begin Date

1/1/2018

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

12/6/2019
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Michael Baker, CEO
(208) 292-0256

Contract Pharmacy Representative

ShopKo
Lorie Neumann, Contracting & Compliance
(920) 429-4726

Signed By Date

10/4/2017

340B Drug Pricing Program Database