340B Drug Pricing Program Database
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ALBERTSONS LLC
CAH131323-00 ST. LUKE'S WOOD RIVER MEDICAL CENTER
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Covered Entity Details
Entity Name
ST. LUKE'S WOOD RIVER MEDICAL CENTER
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH131323-00
Entity Address
100 HOSPITAL DRIVE
KETCHUM, ID 83340
Medicare Provider Number
131323
Participating Start Date
4/1/2011
Last Recertification Date
8/28/2024
Pharmacy Details
Pharmacy Name
ALBERTSONS LLC
Pharmacy Address
SAV-ON PHARMACY #130
911 MAIN ST. NORTH
HAILEY, ID 83333
Pharmacy Comments
Contract Details
Approval Date
10/16/2017
Contract Begin Date
1/1/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Peter DiDio, Vice President, Controller
(208) 381-1251
Contract Pharmacy Representative
Albertsons Companies
Chuck Hanson, Senior 340B Program Manager
(208) 395-6304
Signed By Date
10/16/2017
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