Contract Pharmacy Details

ALBERTSONS LLC
DSH270012 BENEFIS HOSPITALS INC.

Covered Entity Details

Entity Name

BENEFIS HOSPITALS INC.

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH270012

Entity Address

1101 26TH STREET SOUTH
GREAT FALLS, MT 59405

Medicare Provider Number

270012

Participating Start Date

1/1/2019

Last Recertification Date

8/21/2024

Pharmacy Details

Pharmacy Name

ALBERTSONS LLC

Pharmacy Address

OSCO PHARMACY #37
2250 10TH AVENUE SOUTH
GREAT FALLS, MT 59405

Pharmacy Comments

Contract Details

Approval Date

11/19/2018

Contract Begin Date

1/1/2019

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Terry Olinger, President
(406) 455-5477

Contract Pharmacy Representative

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

Signed By Date

10/31/2018

340B Drug Pricing Program Database