Contract Pharmacy Details

SAFEWAY INC
CH10102W Sea Mar Community Health Centers

Covered Entity Details

Entity Name

Sea Mar Community Health Centers

Subdivision Name

Sea Mar CHC - Puyallup 125th Street Ct. E.

Type

HRSA-Funded Health Center

340B ID

CH10102W

Entity Address

10217 125th Street Ct E
Puyallup, WA 98374

Grant Number

H80CS00445

Participating Start Date

1/1/2005

Last Recertification Date

2/17/2025

Pharmacy Details

Pharmacy Name

SAFEWAY INC

Pharmacy Address

SAFEWAY PHARMACY #2640
13308 MERIDIAN E
PUYALLUP, WA 98373

Pharmacy Comments

Contract Details

Approval Date

10/28/2011

Contract Begin Date

10/28/2011

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Mary Bartolo, VP, Deputy Director
(206) 763-5277

Contract Pharmacy Representative

Safeway
Merle Jarvill, Director, Managed Care
(623) 869-4260

Signed By Date

10/21/2011

340B Drug Pricing Program Database