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SAFEWAY INC
CH08017J PUEBLO COMMUNITY HEALTH CENTER
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Covered Entity Details
Entity Name
PUEBLO COMMUNITY HEALTH CENTER
Subdivision Name
Central High School SBWC
Type
HRSA-Funded Health Center
340B ID
CH08017J
Entity Address
216 E Orman Ave
Pueblo, CO 81004-2144
Grant Number
H80CS00692
Participating Start Date
7/1/2009
Last Recertification Date
3/3/2025
Pharmacy Details
Pharmacy Name
SAFEWAY INC
Pharmacy Address
SAFEWAY PHARMACY #3729
1231 SOUTH PRAIRIE AVENUE
PUEBLO, CO 81005
Pharmacy Comments
Contract Details
Approval Date
4/12/2024
Contract Begin Date
7/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Donald Moore, CEO
(719) 543-8718 Ext: 139
Contract Pharmacy Representative
PCHC
Jenna Valentine, Pharmacy Director
(719) 543-8711
Signed By Date
4/12/2024
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