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SAFEWAY INC
DSH500150 LEGACY SALMON CREEK HOSPITAL
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Covered Entity Details
Entity Name
LEGACY SALMON CREEK HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH500150
Entity Address
2211 NE 139TH ST
VANCOUVER, WA 98686
Medicare Provider Number
500150
Participating Start Date
7/1/2007
Last Recertification Date
9/8/2024
Pharmacy Details
Pharmacy Name
SAFEWAY INC
Pharmacy Address
SAFEWAY PHARMACY #1704
6700 NE 162ND AVE STE 500
VANCOUVER, WA 98682
Pharmacy Comments
Contract Details
Approval Date
5/3/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
8/17/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Majid Tanas, VP Pharmacy Services
(503) 415-5011
Contract Pharmacy Representative
Albertsons Companies
Chuck Hanson, Senior 340B Program Manager
(208) 395-6304
Signed By Date
5/3/2023
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