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SAFEWAY INC
CAH271314-00 Powell County Memorial Hospital Association, Inc. DBA Deer Lodge Medical Center
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Covered Entity Details
Entity Name
Powell County Memorial Hospital Association, Inc. DBA Deer Lodge Medical Center
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH271314-00
Entity Address
1100 Hollenbeck Ln
Deer Lodge, MT 59722
Medicare Provider Number
271314
Participating Start Date
10/1/2011
Last Recertification Date
8/21/2024
Pharmacy Details
Pharmacy Name
SAFEWAY INC
Pharmacy Address
SAFEWAY PHARMACY #1581
570 N MONTANA ST
DILLON, MT 59725
Pharmacy Comments
Contract Details
Approval Date
4/23/2020
Contract Begin Date
7/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
5/28/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Tony Pfaff, CEO
(406) 846-2212 Ext: 111
Contract Pharmacy Representative
Albertsons Companies
Chuck Hanson, Senior 340B Program Manager
(208) 395-6304
Signed By Date
4/23/2020
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