Contract Pharmacy Details

RANDALLS FOOD AND DRUGS LP
DSH320002 ST. VINCENT HOSPITAL

Covered Entity Details

Entity Name

ST. VINCENT HOSPITAL

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH320002

Entity Address

455 ST. MICHAELS DRIVE
SANTA FE, NM 87505

Medicare Provider Number

320002

Participating Start Date

1/1/2014

Last Recertification Date

8/23/2024

Pharmacy Details

Pharmacy Name

RANDALLS FOOD AND DRUGS LP

Pharmacy Address

RANDALLS PHARMACY #2483
715 S. EXPOSITION
AUSTIN, TX 78703

Pharmacy Comments

Contract Details

Approval Date

1/12/2018

Contract Begin Date

4/1/2018

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Patrick B. Carrier, President & CEO
(505) 913-5202

Contract Pharmacy Representative

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

Signed By Date

1/12/2018

340B Drug Pricing Program Database