Contract Pharmacy Details

SAFEWAY INC
DSH380022 SAMARITAN ALBANY GENERAL HOSPITAL

Covered Entity Details

Entity Name

SAMARITAN ALBANY GENERAL HOSPITAL

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH380022

Entity Address

1046 6TH AVE SW
ALBANY, OR 97321

Medicare Provider Number

380022

Participating Start Date

4/1/2012

Last Recertification Date

8/23/2024

Pharmacy Details

Pharmacy Name

SAFEWAY INC

Pharmacy Address

SAFEWAY PHARMACY #4333
450 SW 3RD ST
CORVALLIS, OR 97333

Pharmacy Comments

11/18/10 UPDATED (WAS ZIP: 97339);

Contract Details

Approval Date

7/17/2018

Contract Begin Date

10/1/2018

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

9/9/2024
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

DANIEL B. SMITH, VP FINANCE/CFO
(541) 768-5390

Contract Pharmacy Representative

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

Signed By Date

7/17/2018

340B Drug Pricing Program Database