Contract Pharmacy Details

ALBERTSON'S LLC
CH100180 HEALTH WEST INC

Covered Entity Details

Entity Name

HEALTH WEST INC

Subdivision Name

HEALTH WEST - ADMINISTRATION OFFICES

Type

HRSA-Funded Health Center

340B ID

CH100180

Entity Address

500 S 11th AVE
POCATELLO, ID 83201-4835

Grant Number

H80CS00321

Participating Start Date

4/1/2004

Last Recertification Date

2/12/2025

Pharmacy Details

Pharmacy Name

ALBERTSON'S LLC

Pharmacy Address

SAV-ON PHARMACY #3342
1323 DEWAR DRIVE
ROCK SPRINGS, WY 82901

Pharmacy Comments

Contract Details

Approval Date

4/8/2024

Contract Begin Date

7/1/2024

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Mark T Horrocks, Chief Medical Officer
(208) 232-7862

Contract Pharmacy Representative

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

Signed By Date

4/8/2024

340B Drug Pricing Program Database