Contract Pharmacy Details

SAFEWAY INC
CH107930 KODIAK ISLAND HEALTH CARE FOUNDATION

Covered Entity Details

Entity Name

KODIAK ISLAND HEALTH CARE FOUNDATION

Subdivision Name

KODIAK COMMUNITY HEALTH CENTER

Type

HRSA-Funded Health Center

340B ID

CH107930

Entity Address

1911 E Rezanof Dr
Kodiak, AK 99615-6602

Grant Number

H80CS01445

Participating Start Date

4/1/2004

Last Recertification Date

2/20/2025

Pharmacy Details

Pharmacy Name

SAFEWAY INC

Pharmacy Address

SAFEWAY PHARMACY #1090
2685 MILL BAY ROAD
KODIAK, AK 99615

Pharmacy Comments

Contract Details

Approval Date

10/15/2014

Contract Begin Date

1/1/2015

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Judy Christine Rathje, Executive Director/CEO
(907) 481-5005

Contract Pharmacy Representative

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

Signed By Date

10/15/2014

340B Drug Pricing Program Database