Contract Pharmacy Details

ALBERTSONS LLC
SCH270012-00 BENEFIS HOSPITALS, INC.

Covered Entity Details

Entity Name

BENEFIS HOSPITALS, INC.

Subdivision Name

Type

Sole Community Hospital

340B ID

SCH270012-00

Entity Address

1101 26TH STREET SOUTH
GREAT FALLS, MT 59405

Medicare Provider Number

270012

Participating Start Date

1/1/2011

Last Recertification Date

8/23/2018

Entity Termination Date

1/1/2019

Pharmacy Details

Pharmacy Name

ALBERTSONS LLC

Pharmacy Address

OSCO PHARMACY #33
501 WEST MAIN STREET
CUT BANK, MT 59427

Pharmacy Comments

Contract Details

Approval Date

10/7/2016

Contract Begin Date

1/1/2017

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

1/11/2018
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Terry Olinger, President
(406) 455-5477

Contract Pharmacy Representative

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

Signed By Date

10/7/2016

340B Drug Pricing Program Database