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SAFEWAY INC
CAH381318-00 PROVIDENCE HOOD RIVER MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
PROVIDENCE HOOD RIVER MEMORIAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH381318-00
Entity Address
810 12th Street
HOOD RIVER, OR 97031-1587
Medicare Provider Number
381318
Participating Start Date
4/1/2011
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
SAFEWAY INC
Pharmacy Address
SAFEWAY PHARMACY #1489
520 MT HOOD ST
THE DALLES, OR 97058-3555
Pharmacy Comments
Contract Details
Approval Date
4/2/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jeanette Carol Vieira, CEO
(541) 387-6456
Contract Pharmacy Representative
Albertsons Companies
Chuck Hanson, Senior 340B Program Manager
(208) 395-6304
Signed By Date
4/2/2019
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