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SAFEWAY INC
DSH500030 ST. JOSEPH MEDICAL CENTER
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Covered Entity Details
Entity Name
ST. JOSEPH MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH500030
Entity Address
2901 SQUALICUM PARKWAY
BELLINGHAM, WA 98225-1851
Medicare Provider Number
500030
Participating Start Date
10/1/2018
Last Recertification Date
8/18/2024
Pharmacy Details
Pharmacy Name
SAFEWAY INC
Pharmacy Address
HAGGEN PHARMACY #3460
2900 WOBURN ST
BELLINGHAM, WA 98226
Pharmacy Comments
Contract Details
Approval Date
1/15/2019
Contract Begin Date
4/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Eric Terence Brettner, Chief Financial Officer
(360) 788-6834 Ext: 6834
Contract Pharmacy Representative
Safeway
Charles Hanson, 340B Program Manager: Pharmacy Managed Care
(208) 395-6304
Signed By Date
1/15/2019
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