Contract Pharmacy Details

ALBERTSON'S LLC
DSH500003 SKAGIT VALLEY HOSPITAL

Covered Entity Details

Entity Name

SKAGIT VALLEY HOSPITAL

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH500003

Entity Address

1415 EAST KINCAID
MOUNT VERNON, WA 98274-4126

Medicare Provider Number

500003

Participating Start Date

7/1/2006

Last Recertification Date

8/21/2024

Pharmacy Details

Pharmacy Name

ALBERTSON'S LLC

Pharmacy Address

SAV-ON PHARMACY #471
301 MARYSVILLE MALL #60
MARYSVILLE, WA 98270

Pharmacy Comments

Contract Details

Approval Date

7/13/2016

Contract Begin Date

10/1/2016

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

3/21/2022
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

THOMAS LITAKER, CFO
(360) 445-8505

Contract Pharmacy Representative

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

Signed By Date

7/13/2016

340B Drug Pricing Program Database