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SAFEWAY INC
STD850151 CAN Community Health, Inc
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Covered Entity Details
Entity Name
CAN Community Health, Inc
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD850151
Entity Address
4244 N. 19th Avenue
Phoenix, AZ 85015
Grant Number
6 NU62PS924818-01-01
Participating Start Date
1/1/2020
Last Recertification Date
5/28/2025
Pharmacy Details
Pharmacy Name
SAFEWAY INC
Pharmacy Address
SAFEWAY PHARMACY #1591
6202 S. 16TH STREET
PHOENIX, AZ 85040
Pharmacy Comments
Contract Details
Approval Date
1/22/2020
Contract Begin Date
4/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Richard E. Carlisle, President & CEO
(941) 366-0134 Ext: 11111
Contract Pharmacy Representative
Albertsons Companies
Chuck Hanson, Senior 340B Program Manager
(208) 395-6304
Signed By Date
1/22/2020
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