Contract Pharmacy Details

SAFEWAY INC
STD850153 CAN Community Health, Inc.

Covered Entity Details

Entity Name

CAN Community Health, Inc.

Subdivision Name

AZ Suite 6

Type

Sexually Transmitted Diseases

340B ID

STD850153

Entity Address

4350 N 19th Avenue
Suite 6
Phoenix, AZ 85015

Grant Number

6 NU62PS924818-01-01

Participating Start Date

1/1/2020

Last Recertification Date

5/27/2024

Pharmacy Details

Pharmacy Name

SAFEWAY INC

Pharmacy Address

SAFEWAY PHARMACY #1549
14696 N FRANK LLOYD WRIGHT BLV
SCOTTSDALE, AZ 85260

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

340B Drug Pricing Program Database