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SAFEWAY INC
CH08126B Mountain Family Health Centers
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Covered Entity Details
Entity Name
Mountain Family Health Centers
Subdivision Name
Mountain Family Health Centers Glenwood Springs
Type
HRSA-Funded Health Center
340B ID
CH08126B
Entity Address
1905 BLAKE AVE
STE 101
GLENWOOD SPRINGS, CO 81601-4206
Grant Number
H80CS00830
Participating Start Date
10/1/1999
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
SAFEWAY INC
Pharmacy Address
SAFEWAY PHARMACY #0390
2425 MINER STREET
PO BOX 70
IDAHO SPRINGS, CO 80452
Pharmacy Comments
Contract Details
Approval Date
7/10/2015
Contract Begin Date
10/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2019
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Ross Brooks, CEO
(970) 945-2840
Contract Pharmacy Representative
Syed Hashmi, 340B Program Manager
(925) 467-2807
Signed By Date
7/10/2015
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