Contract Pharmacy Details

UNITED SUPERMARKETS, LLC
DSH320001 UNIVERSITY OF NEW MEXICO HOSPITAL

Covered Entity Details

Entity Name

UNIVERSITY OF NEW MEXICO HOSPITAL

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH320001

Entity Address

2211 Lomas Blvd NE
ALBUQUERQUE, NM 87106

Medicare Provider Number

320001

Participating Start Date

9/1/1993

Last Recertification Date

8/29/2024

Pharmacy Details

Pharmacy Name

UNITED SUPERMARKETS, LLC

Pharmacy Address

ALBERTSONS MARKET PHARMACY #986
3542 ZAFARANO DR
SANTA FE, NM 87507

Pharmacy Comments

Contract Details

Approval Date

10/14/2018

Contract Begin Date

1/1/2019

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

3/1/2024
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Bonnie White, Chief Financial Officer
(505) 272-1840

Contract Pharmacy Representative

Albertsons Companies
Chuck Hanson, Senior 340B Program Manager
(208) 395-6304

Signed By Date

10/14/2018

340B Drug Pricing Program Database