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SAFEWAY INC
DSH380060 Portland Adventist Medical Center dba Adventist Health Portland
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Covered Entity Details
Entity Name
Portland Adventist Medical Center dba Adventist Health Portland
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH380060
Entity Address
10123 SE Market Street
Portland, OR 97216
Medicare Provider Number
380060
Participating Start Date
10/1/2011
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
SAFEWAY INC
Pharmacy Address
SAFEWAY PHARMACY #2696
14840 SW WEBSTER ROAD
MILWUAKIE, OR 97267
Pharmacy Comments
Contract Details
Approval Date
1/12/2021
Contract Begin Date
4/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Donald E. Welch, CFO
(503) 261-4406
Contract Pharmacy Representative
Albertsons Companies
Chuck Hanson, Senior 340B Program Manager
(208) 395-6304
Signed By Date
1/12/2021
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