Contract Pharmacy Details

AMAZON PHARMACY #001
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

AMAZON PHARMACY #001

Pharmacy Address

4500 S PLEASANT VALLEY RD STE 201
AUSTIN, TX 78744-2911

Pharmacy Comments

Contract Details

Approval Date

1/15/2018

Contract Begin Date

4/1/2018

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

5/17/2024
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Michael Baker, CEO
(208) 292-0256

Contract Pharmacy Representative

PillPack, Inc.
Geoff Swindle, Administrator
(855) 745-5725

Signed By Date

1/15/2018

340B Drug Pricing Program Database