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ALBERTSON'S LLC
DSH500058 Kadlec Regional Medical Center
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Covered Entity Details
Entity Name
Kadlec Regional Medical Center
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH500058
Entity Address
888 SWIFT BOULEVARD
RICHLAND, WA 99352
Medicare Provider Number
500058
Participating Start Date
7/1/2007
Last Recertification Date
9/5/2024
Pharmacy Details
Pharmacy Name
ALBERTSON'S LLC
Pharmacy Address
SAFEWAY PHARMACY #3253
5204 W. CLEARWATER AVE.
KENNEWICK, WA 99336
Pharmacy Comments
Contract Details
Approval Date
4/15/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Spencer Dwayne Harris, CFO
(509) 942-2708
Contract Pharmacy Representative
Albertsons Companies
Chuck Hanson, Senior 340B Program Manager
(208) 395-6304
Signed By Date
4/15/2019
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