Contract Pharmacy Details

ALBERTSONS LLC
SCH320016-00 GILA REGIONAL MEDICAL CENTER

Covered Entity Details

Entity Name

GILA REGIONAL MEDICAL CENTER

Subdivision Name

Type

Sole Community Hospital

340B ID

SCH320016-00

Entity Address

1313 E 32ND STREET
SILVER CITY, NM 88061

Medicare Provider Number

320016

Participating Start Date

4/1/2018

Last Recertification Date

8/19/2021

Entity Termination Date

7/1/2022

Pharmacy Details

Pharmacy Name

ALBERTSONS LLC

Pharmacy Address

SAV-ON PHARMACY #3914
1956 HIGHWAY 180 EAST
SILVER CITY, NM 88061

Pharmacy Comments

Contract Details

Approval Date

4/9/2021

Contract Begin Date

7/1/2021

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

7/1/2022
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Gregory W Brickner, Interim CFO
(575) 538-4130

Contract Pharmacy Representative

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

Signed By Date

4/9/2021

340B Drug Pricing Program Database