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ALBERTSONS LLC
DSH060030 BANNER MCKEE MEDICAL CENTER
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Covered Entity Details
Entity Name
BANNER MCKEE MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH060030
Entity Address
2000 BOISE AVENUE
LOVELAND, CO 80538
Medicare Provider Number
060030
Participating Start Date
3/15/2022
Last Recertification Date
8/30/2022
Entity Termination Date
7/1/2023
Pharmacy Details
Pharmacy Name
ALBERTSONS LLC
Pharmacy Address
SAFEWAY PHARMACY # 876
731 S LEMAY
FORT COLLINS, CO 80524
Pharmacy Comments
Contract Details
Approval Date
1/7/2019
Contract Begin Date
4/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
3/6/2020
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Krista Touros, CFO - Western Division
(970) 810-1567
Contract Pharmacy Representative
Albertsons Companies
Chuck Hanson, Senior 340B Program Manager
(208) 395-6304
Signed By Date
1/7/2019
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