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SAFEWAY INC
CH09287E CHIRICAHUA COMMUNITY HEALTH CENTERS INC
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Covered Entity Details
Entity Name
CHIRICAHUA COMMUNITY HEALTH CENTERS INC
Subdivision Name
Chiricahua Community Health Centers Inc. Pediatric Center of Excellence
Type
HRSA-Funded Health Center
340B ID
CH09287E
Entity Address
815 15th Street
Douglas, AZ 85607
Grant Number
H80CS00696
Participating Start Date
4/1/2012
Last Recertification Date
3/3/2025
Pharmacy Details
Pharmacy Name
SAFEWAY INC
Pharmacy Address
SAFEWAY PHARMACY #0272
650 N BISBEE AVENUE
WILLCOX, AZ 85643
Pharmacy Comments
Contract Details
Approval Date
10/16/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jonathan Melk, CEO
(520) 227-9167
Contract Pharmacy Representative
Albertsons
Ronald Richmon, Group Director of Managed Care
(630) 948-6285
Signed By Date
10/16/2023
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