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ALBERTSONS LLC
RRC270004-00 Billings Clinic Hospital
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Covered Entity Details
Entity Name
Billings Clinic Hospital
Subdivision Name
Type
Rural Referral Center
340B ID
RRC270004-00
Entity Address
2800 10th Ave. N
Billings, MT 59101-4000
Medicare Provider Number
270004
Participating Start Date
1/1/2012
Last Recertification Date
8/17/2015
Entity Termination Date
1/1/2016
Pharmacy Details
Pharmacy Name
ALBERTSONS LLC
Pharmacy Address
OSCO PHARMACY #4025
611 NORTH 27TH STREET
BILLINGS, MT 59101
Pharmacy Comments
Contract Details
Approval Date
10/9/2013
Contract Begin Date
1/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2016
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Lu Byrd, Vice President/Hospital Operations
(406) 238-2328
Contract Pharmacy Representative
Kori Miller, Pharmacist in Charge
(406) 259-1441
Signed By Date
10/9/2013
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