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ALBERTSONS LLC
CAH131307-00 Weiser Valley Hospital District, dba Weiser Memorial Hospital
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Covered Entity Details
Entity Name
Weiser Valley Hospital District, dba Weiser Memorial Hospital
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH131307-00
Entity Address
645 East 5th Street
Weiser, ID 83672
Medicare Provider Number
131307
Participating Start Date
7/1/2013
Last Recertification Date
8/21/2024
Pharmacy Details
Pharmacy Name
ALBERTSONS LLC
Pharmacy Address
SAV-ON PHARMACY #168
405 S MAIN ST
PAYETTE, ID 83661
Pharmacy Comments
Contract Details
Approval Date
4/13/2017
Contract Begin Date
7/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
3/13/2025
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Steve Hale, CEO
(208) 549-4450
Contract Pharmacy Representative
Albertsons Companies
Chuck Hanson, Senior 340B Program Manager
(208) 395-6304
Signed By Date
4/13/2017
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