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ALBERTSON'S LLC
CAH531312-00 West Park Hospital District
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Covered Entity Details
Entity Name
West Park Hospital District
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH531312-00
Entity Address
707 Sheridan Ave
Cody, WY 82414
Medicare Provider Number
531312
Participating Start Date
7/1/2012
Last Recertification Date
8/29/2024
Pharmacy Details
Pharmacy Name
ALBERTSON'S LLC
Pharmacy Address
OSCO PHARMACY #2061
1825 17TH STREET
CODY, WY 82414
Pharmacy Comments
Contract Details
Approval Date
9/29/2020
Contract Begin Date
10/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Douglas McMillan, CEO
(307) 578-2274
Contract Pharmacy Representative
Albertsons Companies
Chuck Hanson, Senior 340B Program Manager
(208) 395-6304
Signed By Date
9/29/2020
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