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SAFEWAY INC
CAH381303-00 PROVIDENCE HEALTH DBA PROVIDENCE SEASIDE HOSPITAL
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Covered Entity Details
Entity Name
PROVIDENCE HEALTH DBA PROVIDENCE SEASIDE HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH381303-00
Entity Address
725 S. WAHANNA RD.
SEASIDE, OR 97138-7735
Medicare Provider Number
381303
Participating Start Date
7/1/2011
Last Recertification Date
8/22/2024
Pharmacy Details
Pharmacy Name
SAFEWAY INC
Pharmacy Address
SAFEWAY PHARMACY #1260
401 S ROOSEVELT DR
SEASIDE, OR 97138-6738
Pharmacy Comments
Contract Details
Approval Date
4/14/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Pamela Jill Cooper, Director of Finance
(503) 717-2241
Contract Pharmacy Representative
Albertsons Companies
Chuck Hanson, Senior 340B Program Manager
(208) 395-6304
Signed By Date
4/14/2019
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