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ALBERTSONS LLC
STD598026 Blue Mountain Clinic
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Covered Entity Details
Entity Name
Blue Mountain Clinic
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD598026
Entity Address
610 N. California St
Missoula, MT 59802
Grant Number
6 NH25PS005168-05-04
Participating Start Date
4/1/2022
Last Recertification Date
5/6/2024
Pharmacy Details
Pharmacy Name
ALBERTSONS LLC
Pharmacy Address
OSCO PHARMACY #1010
3800 RUSSELL STREET
MISSOULA, MT 59801
Pharmacy Comments
Contract Details
Approval Date
4/21/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
3/6/2025
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Nicole Kristine Smith, Executive Director
(406) 541-4378
Contract Pharmacy Representative
Albertsons Companies
Chuck Hanson, Senior 340B Program Manager
(208) 395-6304
Signed By Date
4/21/2023
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