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SAFEWAY INC
SCH030007-00 VERDE VALLEY MEDICAL CENTER
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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 #1207
2300 W HIGHWAY 89A
SEDONA, AZ 86336
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
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