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SAFEWAY INC
FQHC638337A TULALIP TRIBES
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Covered Entity Details
Entity Name
TULALIP TRIBES
Subdivision Name
TULALIP HEALTH CLINIC
Type
Tribal Contract/Compact with IHS (P.L. 93-638)
340B ID
FQHC638337A
Entity Address
7520 Totem Beach Road
Tulalip, WA 98271
Grant Number
Participating Start Date
4/2/2020
Last Recertification Date
2/14/2025
Pharmacy Details
Pharmacy Name
SAFEWAY INC
Pharmacy Address
HAGGEN PHARMACY #3480
26603 72ND AVENUE NW
STANWOOD, WA 98292
Pharmacy Comments
Contract Details
Approval Date
7/13/2023
Contract Begin Date
10/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Melody Kiser, Interim Health Administrator
(360) 716-4326
Contract Pharmacy Representative
Albertsons Companies
Chuck Hanson, Senior 340B Program Manager
(208) 395-6304
Signed By Date
7/13/2023
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