Contract Pharmacy Details

SAFEWAY INC
FQHC638398 JAMESTOWN S'KLALLAM TRIBE

Covered Entity Details

Entity Name

JAMESTOWN S'KLALLAM TRIBE

Subdivision Name

Jamestown Family Health Clinic

Type

Tribal Contract/Compact with IHS (P.L. 93-638)

340B ID

FQHC638398

Entity Address

808 N. 5th Avenue
SEQUIM, WA 98382

Grant Number

Participating Start Date

1/1/2001

Last Recertification Date

3/5/2025

Pharmacy Details

Pharmacy Name

SAFEWAY INC

Pharmacy Address

SAFEWAY PHARMACY #1922
2709 E. HIGHWAY 101
PORT ANGELES, WA 98362

Pharmacy Comments

Contract Details

Approval Date

7/8/2015

Contract Begin Date

10/1/2015

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Brent D. Simcosky, Director of Health Services
(360) 582-4870

Contract Pharmacy Representative

Syed Hashmi, 340B Program Manager
(925) 467-2807

Signed By Date

7/8/2015

340B Drug Pricing Program Database