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ALBERTSONS LLC
DSH270004 BILLINGS CLINIC
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Covered Entity Details
Entity Name
BILLINGS CLINIC
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH270004
Entity Address
2800 TENTH AVENUE NORTH
BILLINGS, MT 59101
Medicare Provider Number
270004
Participating Start Date
1/1/2016
Last Recertification Date
8/20/2024
Pharmacy Details
Pharmacy Name
ALBERTSONS LLC
Pharmacy Address
ALBERTSONS PHARMACY #3367
5317 GRAND AVE
BILLINGS, MT 59106
Pharmacy Comments
Contract Details
Approval Date
2/28/2023
Contract Begin Date
3/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Chad W Miller, Vice President Clinic Operations
(406) 657-4603
Contract Pharmacy Representative
Albertsons
Ronald Richmon, Group Director of Managed Care
(630) 948-6285
Signed By Date
2/28/2023
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