Contract Pharmacy Details

SAFEWAY INC
SCH030007-00 VERDE VALLEY MEDICAL CENTER

Covered Entity Details

Entity Name

VERDE VALLEY MEDICAL CENTER

Subdivision Name

Type

Sole Community Hospital

340B ID

SCH030007-00

Entity Address

269 SOUTH CANDY LANE
COTTONWOOD, AZ 86326

Medicare Provider Number

030007

Participating Start Date

9/30/2010

Last Recertification Date

9/9/2024

Pharmacy Details

Pharmacy Name

SAFEWAY INC

Pharmacy Address

SAFEWAY PHARMACY #2052
1635 E COTTONWOOD STREET
COTTONWOOD, AZ 86326

Pharmacy Comments

Contract Details

Approval Date

7/15/2020

Contract Begin Date

10/1/2020

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

7/14/2021
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Clifford F Loader, Chief Financial Officer
(928) 773-2282

Contract Pharmacy Representative

Albertsons Companies
Chuck Hanson, Senior 340B Program Manager
(208) 395-6304

Signed By Date

7/15/2020

340B Drug Pricing Program Database