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WAL-MART PHARMACY 10-2782
CH101610 GLENNS FERRY HEALTH CENTER, Inc.
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Covered Entity Details
Entity Name
GLENNS FERRY HEALTH CENTER, Inc.
Subdivision Name
DESERT SAGE HEALTH CENTERS
Type
HRSA-Funded Health Center
340B ID
CH101610
Entity Address
486 W. FIRST AVE.
GLENNS FERRY, ID 83623
Grant Number
H80CS00473
Participating Start Date
10/1/1998
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-2782
Pharmacy Address
2745 AMERICAN LEGION BLVD
MOUNTAIN HOME, ID 83647
Pharmacy Comments
Contract Details
Approval Date
6/14/2012
Contract Begin Date
6/14/2012
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
LESLYN PHELPS, CEO
(208) 366-2044
Contract Pharmacy Representative
Wal--Mart
Marcus Osborne, Sales & Contracting
(479) 204-8452
Signed By Date
6/8/2012
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