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ALBERTSONS LLC
DSH450024 UNIVERSITY MEDICAL CENTER OF EL PASO
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Covered Entity Details
Entity Name
UNIVERSITY MEDICAL CENTER OF EL PASO
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH450024
Entity Address
4815 ALAMEDA AVE.
EL PASO, TX 79905
Medicare Provider Number
450024
Participating Start Date
12/1/1992
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
ALBERTSONS LLC
Pharmacy Address
SAVON PHARMACY #3932
7022 N. MESA ST
EL PASO, TX 79912
Pharmacy Comments
Contract Details
Approval Date
10/8/2015
Contract Begin Date
1/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/30/2016
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
MICHAEL NUNEZ, CFO
(915) 521-7626
Contract Pharmacy Representative
Albertsons
Ronald Richmon, Group Director of Managed Care
(630) 948-6285
Signed By Date
10/8/2015
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