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SAFEWAY INC
CH105600 Mosaic Community Health
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Covered Entity Details
Entity Name
Mosaic Community Health
Subdivision Name
Madras Health Center
Type
HRSA-Funded Health Center
340B ID
CH105600
Entity Address
500 NE A St Ste 100
Madras, OR 97741
Grant Number
H80CS00270
Participating Start Date
10/1/2003
Last Recertification Date
2/25/2025
Pharmacy Details
Pharmacy Name
SAFEWAY INC
Pharmacy Address
SAFEWAY PHARMACY #1888
320 SW CENTURY DR
BEND, OR 97702-3037
Pharmacy Comments
Contract Details
Approval Date
4/14/2015
Contract Begin Date
7/1/2015
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Mark Petersen, Director of Finance
(541) 383-3005
Contract Pharmacy Representative
Safeway
Thuy Le, 340B Program Manager
(925) 467-2825
Signed By Date
4/14/2015
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