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FRED MEYER INC
DSH380022 SAMARITAN ALBANY GENERAL HOSPITAL
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Covered Entity Details
Entity Name
SAMARITAN ALBANY GENERAL HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH380022
Entity Address
1046 6TH AVE SW
ALBANY, OR 97321
Medicare Provider Number
380022
Participating Start Date
4/1/2012
Last Recertification Date
8/23/2024
Pharmacy Details
Pharmacy Name
FRED MEYER INC
Pharmacy Address
PHARMACY
777 NW KINGS BLVD
CORVALLIS, OR 97330
Pharmacy Comments
Contract Details
Approval Date
7/17/2018
Contract Begin Date
10/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/8/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
DANIEL B. SMITH, VP FINANCE/CFO
(541) 768-5390
Contract Pharmacy Representative
Kroger
Anastasia Frey, Senior Manager, Payor Contracting
(513) 698-1875
Signed By Date
7/17/2018
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