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SAFEWAY INC
CH10560S Mosaic Community Health
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Covered Entity Details
Entity Name
Mosaic Community Health
Subdivision Name
Madras High School-Based Health Center
Type
HRSA-Funded Health Center
340B ID
CH10560S
Entity Address
390 SE 10th St
Madras, OR 97741
Grant Number
H80CS00270
Participating Start Date
7/1/2017
Last Recertification Date
2/25/2025
Pharmacy Details
Pharmacy Name
SAFEWAY INC
Pharmacy Address
SAFEWAY PHARMACY #1960
80 NE CEDAR STREET
MADRAS, OR 97741
Pharmacy Comments
Contract Details
Approval Date
10/12/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Robin Vallie, Pharmacy Operations Manager
(541) 383-3005
Contract Pharmacy Representative
Safeway
Thuy Le, 340B Program Manager
(925) 467-2825
Signed By Date
10/12/2023
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