Contract Pharmacy Details

SAFEWAY INC
CH10792D COUNTY OF LANE

Covered Entity Details

Entity Name

COUNTY OF LANE

Subdivision Name

Riverstone Clinic

Type

HRSA-Funded Health Center

340B ID

CH10792D

Entity Address

2073 Olympic St
Springfield, OR 97477-3413

Grant Number

H80CS01443

Participating Start Date

4/1/2004

Last Recertification Date

2/10/2025

Pharmacy Details

Pharmacy Name

SAFEWAY INC

Pharmacy Address

SAFEWAY PHARMACY #1094
1891 PIONEER PKWY E
SPRINGFIELD, OR 97477

Pharmacy Comments

Contract Details

Approval Date

8/15/2009

Contract Begin Date

8/15/2009

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Contract Pharmacy Representative

DAVID L. WILDEN, DIRECTOR OF PHARMACY
(503) 365-2174

Signed By Date

8/11/2009

340B Drug Pricing Program Database