Contract Pharmacy Details

UNITED SUPERMARKETS, LLC
DSH320089 UNM SANDOVAL REGIONAL MEDICAL CENTER

Covered Entity Details

Entity Name

UNM SANDOVAL REGIONAL MEDICAL CENTER

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH320089

Entity Address

3001 BROADMOOR BLVD NE
RIO RANCHO, NM 87144

Medicare Provider Number

320089

Participating Start Date

4/1/2016

Last Recertification Date

8/17/2023

Entity Termination Date

4/1/2024

Pharmacy Details

Pharmacy Name

UNITED SUPERMARKETS, LLC

Pharmacy Address

ALBERTSONS MARKET PHARMACY #923
7800 ENCHANTED HILLS BLVD NE
RIO RANCHO, NM 87144

Pharmacy Comments

Contract Details

Approval Date

7/8/2020

Contract Begin Date

10/1/2020

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

4/1/2024
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Jamie Silva-Steele, President and CEO
(505) 994-7430

Contract Pharmacy Representative

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

Signed By Date

7/8/2020

340B Drug Pricing Program Database