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SAFEWAY INC
CH102480 COWLITZ FAMILY HEALTH CENTER
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Covered Entity Details
Entity Name
COWLITZ FAMILY HEALTH CENTER
Subdivision Name
COWLITZ FAMILY HEALTH CENTER
Type
HRSA-Funded Health Center
340B ID
CH102480
Entity Address
1057 12th Ave
Longview, WA 98632-2509
Grant Number
H80CS00542
Participating Start Date
1/1/2004
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
SAFEWAY INC
Pharmacy Address
SAFEWAY PHARMACY #1078
2930 OCEAN BEACH HWY
LONGVIEW, WA 98632
Pharmacy Comments
Contract Details
Approval Date
1/16/2015
Contract Begin Date
4/1/2015
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
DIAN COOPER, CEO
(360) 636-3892
Contract Pharmacy Representative
Safeway
Thuy Le, 340B Program Manager
(925) 467-2825
Signed By Date
1/16/2015
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