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SHAVER PHARMACY & COMPOUNDING CTR
CH100180 HEALTH WEST INC
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Covered Entity Details
Entity Name
HEALTH WEST INC
Subdivision Name
HEALTH WEST - ADMINISTRATION OFFICES
Type
HRSA-Funded Health Center
340B ID
CH100180
Entity Address
500 S 11th AVE
POCATELLO, ID 83201-4835
Grant Number
H80CS00321
Participating Start Date
4/1/2004
Last Recertification Date
2/12/2025
Pharmacy Details
Pharmacy Name
SHAVER PHARMACY & COMPOUNDING CTR
Pharmacy Address
235 S 4TH AVE
POCATELLO, ID 83201-6438
Pharmacy Comments
Contract Details
Approval Date
4/13/2018
Contract Begin Date
7/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/31/2022
Pharmacy closed
Contacts
Covered Entity Signing Official
Mindy Benedetti, CEO
(208) 232-7862 Ext: 1120
Contract Pharmacy Representative
Shaver Pharmacy and Compounding Ctr
Tori Shaver, President
(208) 233-3341
Signed By Date
4/13/2018
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