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SAFEWAY INC
CH10076H NORTHWEST HUMAN SERVICES, INC.
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Covered Entity Details
Entity Name
NORTHWEST HUMAN SERVICES, INC.
Subdivision Name
TOTAL HEALTH COMMUNIITY CLINIC
Type
HRSA-Funded Health Center
340B ID
CH10076H
Entity Address
180 ATWATER STREET, N
MONMOUTH, OR 97361
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 #1516
4990 N. RIVER ROAD
KEIZER, OR 97303
Pharmacy Comments
Contract Details
Approval Date
7/12/2023
Contract Begin Date
10/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
PAUL LOGAN, CEO
(503) 588-5828 Ext: 831
Contract Pharmacy Representative
Welllpartner
Kristen Hartlen, Sr. Account Manager
(480) 364-2573
Signed By Date
7/12/2023
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