Contract Pharmacy Details

ALBERTSONS LLC
DSH270051 KALISPELL REGIONAL MEDICAL CENTER d/b/a LOGAN HEALTH MEDICAL CENTER

Covered Entity Details

Entity Name

KALISPELL REGIONAL MEDICAL CENTER d/b/a LOGAN HEALTH MEDICAL CENTER

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH270051

Entity Address

310 SUNNYVIEW LANE
KALISPELL, MT 59901

Medicare Provider Number

270051

Participating Start Date

1/1/2021

Last Recertification Date

8/14/2024

Pharmacy Details

Pharmacy Name

ALBERTSONS LLC

Pharmacy Address

OSCO PHARMACY #33
501 WEST MAIN STREET
CUT BANK, MT 59427

Pharmacy Comments

Contract Details

Approval Date

4/12/2022

Contract Begin Date

7/1/2022

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

3/1/2024
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

CRAIG O BOYER, Chief Financial Officer
(406) 751-5368

Contract Pharmacy Representative

SAFEWAY
Charles Hanson, 340B Program Manager
(208) 395-6304

Signed By Date

4/12/2022

340B Drug Pricing Program Database