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SAFEWAY INC
STD85013 Your Health and Wellness PLLC
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Covered Entity Details
Entity Name
Your Health and Wellness PLLC
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD85013
Entity Address
3326 N 3rd Avenue
Suite 201
Phoenix, AZ 85013
Grant Number
NU51PS005142
Participating Start Date
7/1/2023
Last Recertification Date
5/19/2025
Pharmacy Details
Pharmacy Name
SAFEWAY INC
Pharmacy Address
SAFEWAY PHARMACY #0174
520 WEST OSBORN ROAD
PHOENIX, AZ 85013
Pharmacy Comments
Contract Details
Approval Date
10/14/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Mark Knoblauch, Owner
(602) 625-7944
Contract Pharmacy Representative
Albertsons Companies
Chuck Hanson, Senior 340B Program Manager
(208) 395-6304
Signed By Date
10/14/2023
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