Contract Pharmacy Details

PILLPACK LLC
CAH131319-01 Minidoka Memorial Hospital

Covered Entity Details

Entity Name

Minidoka Memorial Hospital

Subdivision Name

Minidoka Medical - RHC

Type

Critical Access Hospital

340B ID

CAH131319-01

Entity Address

1308 8th Street 1
Rupert, ID 83350

Medicare Provider Number

131319

Outpatient Facility Provider Number

138507

Participating Start Date

10/1/2016

Last Recertification Date

8/21/2024

Pharmacy Details

Pharmacy Name

PILLPACK LLC

Pharmacy Address

DBA PILLPACK BY AMAZON PHARMACY
250 COMMERCIAL ST STE 2012
MANCHESTER, NH 03101

Pharmacy Comments

Contract Details

Approval Date

1/23/2018

Contract Begin Date

4/1/2018

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

1/1/2023
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Jason Gibbons, CFO
(208) 436-8153

Contract Pharmacy Representative

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

Signed By Date

1/23/2018

340B Drug Pricing Program Database