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CUSTOM RX, LLC

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Company Details

Name: CUSTOM RX, LLC
Jurisdiction: Idaho
Legal type: Limited Liability Company (D)
Status: Active-Existing
Date of registration: 01 Dec 2009 (16 years ago)
Financial Date End: 31 Dec 2025
Entity Number: 275672
Place of Formation: IDAHO
File Number: 275672
ZIP code: 83634
County: Ada County
Principal Address: P.O BOX 246 173 W. 4TH STREET KUNA, ID 83634
Mailing Address: 1207 W KIMRA ST MERIDIAN, ID 83642-2488

Agent

Name Role Address
MIKE HALL Agent 660 E FRANKLIN RD STE 220, MERIDIAN, ID 83642

Member

Name Role Address Appointed On Resigned On
Travis Walthall Member 1207 W. KIMRA, MERIDIAN, ID 83642 2020-11-08 No data
Tina Walthall Member 1207 W. KIMRA, MERIDIAN, ID 83642 2023-11-04 2023-11-04

National Provider Identifier

NPI Number:
1477029577

Authorized Person:

Name:
TRAVIS WALTHALL
Role:
PIC/MANAGING MEMBER
Phone:

Taxonomy:

Selected Taxonomy:
3336C0003X - Community/Retail Pharmacy
Is Primary:
Yes

Contacts:

Fax:
2089224499

Filing

Filing Name Filing Number Filing date
Annual Report 0006032810 2024-12-20
Annual Report 0005461725 2023-11-04
Annual Report 0004999069 2022-11-22
Annual Report 0004476356 2021-11-03
Annual Report 0004062718 2020-11-08

USAspending Awards / Financial Assistance

Date:
2020-04-11
Awarding Agency Name:
Small Business Administration
Transaction Description:
TO AID SMALL BUSINESSES IN MAINTAINING WORK FORCE DURING COVID-19 PANDEMIC.
Obligated Amount:
0.00
Face Value Of Loan:
82100.00
Total Face Value Of Loan:
82100.00
Date:
2017-03-08
Awarding Agency Name:
Small Business Administration
Transaction Description:
TO AID SMALL BUSINESSES WHICH ARE UNABLE TO OBTAIN FINANCING IN THE PRIVATE CREDIT MARKETPLACE
Obligated Amount:
0.00
Face Value Of Loan:
350000.00
Total Face Value Of Loan:
350000.00
Date:
2010-03-31
Awarding Agency Name:
Small Business Administration
Transaction Description:
TO AID SMALL BUSINESSES WHICH ARE UNABLE TO OBTAIN FINANCING IN THE PRIVATE CREDIT MARKETPLACE
Obligated Amount:
0.00
Face Value Of Loan:
-25000.00
Total Face Value Of Loan:
475000.00
Date:
2010-03-16
Awarding Agency Name:
Small Business Administration
Transaction Description:
TO AID SMALL BUSINESSES WHICH ARE UNABLE TO OBTAIN FINANCING IN THE PRIVATE CREDIT MARKETPLACE
Obligated Amount:
0.00
Face Value Of Loan:
-500000.00
Total Face Value Of Loan:
0.00

Paycheck Protection Program

Date Approved:
2020-04-11
Loan Status:
Paid in Full
SBA Guaranty Percentage:
100
Initial Approval Amount:
82100
Current Approval Amount:
82100
Race:
Unanswered
Ethnicity:
Not Hispanic or Latino
Gender:
Male Owned
Veteran:
Non-Veteran
Forgiveness Amount:
82923.25

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Date of last update: 31 May 2025

Sources: Idaho Secretary of State