Contract Pharmacy Details

SAFEWAY INC
CAH281360-00 BOX BUTTE GENERAL HOSPITAL

Covered Entity Details

Entity Name

BOX BUTTE GENERAL HOSPITAL

Subdivision Name

Type

Critical Access Hospital

340B ID

CAH281360-00

Entity Address

2101 BOX BUTTE AVENUE
ALLIANCE, NE 69301

Medicare Provider Number

281360

Participating Start Date

7/1/2019

Last Recertification Date

9/6/2024

Pharmacy Details

Pharmacy Name

SAFEWAY INC

Pharmacy Address

SAFEWAY PHARMACY #0549
500 E. THIRD STREET
ALLIANCE, NE 69301

Pharmacy Comments

Contract Details

Approval Date

7/12/2019

Contract Begin Date

10/1/2019

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Lori Mazanec, Chief Executive Officer
(308) 762-6660

Contract Pharmacy Representative

New Albertsons L. P.
Chuck Hanson, 340 B Program manager
(208) 395-6304

Signed By Date

7/12/2019

340B Drug Pricing Program Database