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WAL-MART CENTRAL FILL 10-2670
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 CENTRAL FILL 10-2670
Pharmacy Address
608 SPRING HILL DR # 3 SUITE 300
SPRING, TX 77386
Pharmacy Comments
Contract Details
Approval Date
1/25/2017
Contract Begin Date
4/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Mary Ferguson, CEO
(208) 366-7416
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
1/25/2017
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