340B Drug Pricing Program Database
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SAFEWAY INC
DSH030002 Banner – University Medical Center Phoenix
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Covered Entity Details
Entity Name
Banner – University Medical Center Phoenix
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH030002
Entity Address
1111 EAST MCDOWELL ROAD
PHOENIX, AZ 85006
Medicare Provider Number
030002
Participating Start Date
9/9/2005
Last Recertification Date
8/12/2024
Pharmacy Details
Pharmacy Name
SAFEWAY INC
Pharmacy Address
SAFEWAY PHARMACY #2042
3132 E CAMELBACK RD
PHOENIX, AZ 85016
Pharmacy Comments
Contract Details
Approval Date
10/15/2018
Contract Begin Date
1/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/10/2021
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Trent S. Blain, Sr Dir Finance
(602) 839-5114
Contract Pharmacy Representative
SAFEWAY
Charles Hanson, 340B Program Manager
(208) 395-6304
Signed By Date
10/15/2018
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