Contract Pharmacy Details

SAFEWAY INC
FQHCLA405 Cascade Aids Project

Covered Entity Details

Entity Name

Cascade Aids Project

Subdivision Name

Prism Health

Type

Health Center Program Look-Alike

340B ID

FQHCLA405

Entity Address

2236 SE Belmont St
Portland, OR 97214-2817

Grant Number

LALCS33965

Participating Start Date

4/16/2020

Last Recertification Date

2/24/2025

Pharmacy Details

Pharmacy Name

SAFEWAY INC

Pharmacy Address

SAFEWAY PHARMACY #3134
2800 SE HAWTHORNE BLVD
PORTLAND, OR 97214

Pharmacy Comments

Contract Details

Approval Date

10/30/2020

Contract Begin Date

1/1/2021

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Tyler A. TerMeer, Executive Director
(503) 278-3810

Contract Pharmacy Representative

Albertsons Companies
Chuck Hanson, Senior 340B Program Manager
(208) 395-6304

Signed By Date

10/30/2020

340B Drug Pricing Program Database