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ALBERTSONS LLC
DSH060024 UNIVERSITY OF COLORADO HOSPITAL
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Covered Entity Details
Entity Name
UNIVERSITY OF COLORADO HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH060024
Entity Address
12605 E 16th Ave
AURORA, CO 80045
Medicare Provider Number
060024
Participating Start Date
12/1/1992
Last Recertification Date
8/22/2024
Pharmacy Details
Pharmacy Name
ALBERTSONS LLC
Pharmacy Address
SAFEWAY PHARMACY #899
6100 S. GUN CLUB ROAD
AURORA, CO 80016
Pharmacy Comments
Contract Details
Approval Date
10/17/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
8/12/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Jon David Alford, CFO
(405) 248-8842
Contract Pharmacy Representative
Albertsons Companies
Chuck Hanson, Senior 340B Program Manager
(208) 395-6304
Signed By Date
10/17/2023
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