Contract Pharmacy Details

SAFEWAY INC
CH108170 Dirne Health Centers, Inc.

Covered Entity Details

Entity Name

Dirne Health Centers, Inc.

Subdivision Name

Heritage Health CDA

Type

HRSA-Funded Health Center

340B ID

CH108170

Entity Address

1090 W Park Pl
Coeur D Alene, ID 83814-2785

Grant Number

H80CS02331

Participating Start Date

4/1/2004

Last Recertification Date

3/5/2025

Pharmacy Details

Pharmacy Name

SAFEWAY INC

Pharmacy Address

SAFEWAY PHARMACY #1470
121 W NEIDER AVENUE
COEUR D ALENE, ID 83815

Pharmacy Comments

Contract Details

Approval Date

4/14/2015

Contract Begin Date

7/1/2015

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Michael Baker, CEO
(208) 292-0256

Contract Pharmacy Representative

Safeway
Thuy Le, 340B Program Manager
(925) 467-2825

Signed By Date

4/14/2015

340B Drug Pricing Program Database