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SAFEWAY INC
CAH381314-00 SAMARITAN PACIFIC HEALTH SERVICES, INC., DBA SAMARITAN PACIFIC COMMUNITIES HOSPITAL
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Covered Entity Details
Entity Name
SAMARITAN PACIFIC HEALTH SERVICES, INC., DBA SAMARITAN PACIFIC COMMUNITIES HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH381314-00
Entity Address
930 SW Abbey Street
NEWPORT, OR 97365
Medicare Provider Number
381314
Participating Start Date
8/3/2010
Last Recertification Date
8/23/2024
Pharmacy Details
Pharmacy Name
SAFEWAY INC
Pharmacy Address
SAFEWAY PHARMACY #0415
4101 NW LOGAN RD
LINCOLN CITY, OR 97367
Pharmacy Comments
Contract Details
Approval Date
7/16/2018
Contract Begin Date
10/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/21/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Daniel Smith, VP Finance/CFO
(541) 768-5390
Contract Pharmacy Representative
Safeway
Charles Hanson, 340B Program Manager: Pharmacy Managed Care
(208) 395-6304
Signed By Date
7/16/2018
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