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SAFEWAY INC
CAH501330-00 ASTRIA SUNNYSIDE HOSPITAL
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Covered Entity Details
Entity Name
ASTRIA SUNNYSIDE HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH501330-00
Entity Address
1016 TACOMA AVE
SUNNYSIDE, WA 98944
Medicare Provider Number
501330
Participating Start Date
1/1/2020
Last Recertification Date
8/27/2024
Pharmacy Details
Pharmacy Name
SAFEWAY INC
Pharmacy Address
SAFEWAY PHARMACY #1660
905 E MEAD AVE
YAKIMA, WA 98903
Pharmacy Comments
Contract Details
Approval Date
10/8/2020
Contract Begin Date
1/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/3/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Sierra Foster, Assistant Administrator
(509) 790-7284
Contract Pharmacy Representative
340BDirect
Thuy Le, Vice President Pharmacy Account Management
(801) 326-3150
Signed By Date
10/8/2020
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