Contract Pharmacy Details

ALBERTSONS LLC
CAH141329-00 MORRISON COMMUNITY HOSPITAL

Covered Entity Details

Entity Name

MORRISON COMMUNITY HOSPITAL

Subdivision Name

Type

Critical Access Hospital

340B ID

CAH141329-00

Entity Address

303 N. JACKSON STREET
MORRISON, IL 61270

Medicare Provider Number

141329

Participating Start Date

1/1/2016

Last Recertification Date

8/15/2024

Pharmacy Details

Pharmacy Name

ALBERTSONS LLC

Pharmacy Address

SAV-ON PHARMACY #169
909 EAST PARKCENTER BLVD
BOISE, ID 83706

Pharmacy Comments

Contract Details

Approval Date

1/10/2018

Contract Begin Date

4/1/2018

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

5/1/2020
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Cami Megli, CFO
(815) 772-5533 Ext: 284

Contract Pharmacy Representative

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

Signed By Date

1/10/2018

340B Drug Pricing Program Database