Contract Pharmacy Details

SAFEWAY INC
CH10236C TILLAMOOK, COUNTY OF

Covered Entity Details

Entity Name

TILLAMOOK, COUNTY OF

Subdivision Name

TILLAMOOK COUNTY CLOVERDALE CLINIC

Type

HRSA-Funded Health Center

340B ID

CH10236C

Entity Address

34335 HIGHWAY 101 S.
CLOVERDALE, OR 97112-9400

Grant Number

H80CS00555

Participating Start Date

7/1/2004

Last Recertification Date

2/27/2019

Entity Termination Date

4/1/2020

Pharmacy Details

Pharmacy Name

SAFEWAY INC

Pharmacy Address

SAFEWAY PHARMACY #0412
1455 EDGEWATER ST NW
SALEM, OR 97304

Pharmacy Comments

Contract Details

Approval Date

6/1/2008

Contract Begin Date

6/1/2008

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

4/1/2020
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Contract Pharmacy Representative

Signed By Date

2/16/2007

340B Drug Pricing Program Database