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SAFEWAY INC
CAH381325-00 GOOD SHEPHERD MEDICAL CENTER
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Covered Entity Details
Entity Name
GOOD SHEPHERD MEDICAL CENTER
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH381325-00
Entity Address
610 N.W. 11TH STREET
HERMISTON, OR 97838
Medicare Provider Number
381325
Participating Start Date
9/29/2010
Last Recertification Date
9/6/2024
Pharmacy Details
Pharmacy Name
SAFEWAY INC
Pharmacy Address
SAFEWAY PHARMACY #0444
990 HWY 395 S
HERMISTON, OR 97838
Pharmacy Comments
Contract Details
Approval Date
7/9/2020
Contract Begin Date
7/24/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
3/3/2025
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
DENNIS BURKE, PRESIDENT/CEO
(541) 667-3409
Contract Pharmacy Representative
Albertsons
Chuch Hansen, 340B Manager
(208) 395-6304
Signed By Date
7/9/2020
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