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CARR-GOTTSTEIN FOODS, CO.
CAH021306-00 PROVIDENCE KODIAK ISLAND MEDICAL CENTER
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Covered Entity Details
Entity Name
PROVIDENCE KODIAK ISLAND MEDICAL CENTER
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH021306-00
Entity Address
1915 E REZANOF DRIVE
ATTN PHARMACY
KODIAK, AK 99615
Medicare Provider Number
021306
Participating Start Date
1/1/2011
Last Recertification Date
8/13/2024
Pharmacy Details
Pharmacy Name
CARR-GOTTSTEIN FOODS, CO.
Pharmacy Address
CARRS PHARMACY #1805
1650 W NORTHERN LIGHTS BLVD
ANCHORAGE, AK 99517
Pharmacy Comments
Contract Details
Approval Date
7/15/2021
Contract Begin Date
10/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
8/31/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Karl E Hertz, Administrator
(907) 486-9567
Contract Pharmacy Representative
Albertsons Companies
Chuck Hanson, Senior 340B Program Manager
(208) 395-6304
Signed By Date
7/15/2021
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