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WATKINS PHARMACY INC
CAH131308-00 CASCADE MEDICAL CENTER
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Covered Entity Details
Entity Name
CASCADE MEDICAL CENTER
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH131308-00
Entity Address
402 Lake Cascade Parkway
CASCADE, ID 83611-0151
Medicare Provider Number
131308
Participating Start Date
4/1/2018
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
WATKINS PHARMACY INC
Pharmacy Address
220 S MAIN ST
CASCADE, ID 83611
Pharmacy Comments
Contract Details
Approval Date
1/12/2018
Contract Begin Date
4/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
6/30/2023
Pharmacy closed
Contacts
Covered Entity Signing Official
Kimberly C Dalrymple, Controller
(208) 382-4285 Ext: 1100
Contract Pharmacy Representative
Cascade Medical Center
Benjarmin Watkins, Mr.
(208) 382-4285
Signed By Date
1/12/2018
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