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SAFEWAY INC
CH10076G NORTHWEST HUMAN SERVICES, INC.
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Covered Entity Details
Entity Name
NORTHWEST HUMAN SERVICES, INC.
Subdivision Name
WEST SALEM CLINIC - MENTAL HEALTH
Type
HRSA-Funded Health Center
340B ID
CH10076G
Entity Address
1233 Edgewater St NW STE B
SALEM, OR 97304
Grant Number
H80CS00148
Participating Start Date
10/1/2004
Last Recertification Date
2/14/2025
Pharmacy Details
Pharmacy Name
SAFEWAY INC
Pharmacy Address
SAFEWAY PHARMACY #0412
1455 EDGEWATER ST NW
SALEM, OR 97304
Pharmacy Comments
Contract Details
Approval Date
5/19/2008
Contract Begin Date
5/19/2008
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Contract Pharmacy Representative
Signed By Date
5/14/2008
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