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SAFEWAY INC
CH09289G NORTH COUNTRY HEALTHCARE, INC.
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Covered Entity Details
Entity Name
NORTH COUNTRY HEALTHCARE, INC.
Subdivision Name
NORTH COUNTRY - WINSLOW SITE
Type
HRSA-Funded Health Center
340B ID
CH09289G
Entity Address
620 WEST LEE STREET
Winslow, AZ 86047-2435
Grant Number
H80CS00651
Participating Start Date
7/1/2010
Last Recertification Date
2/18/2025
Pharmacy Details
Pharmacy Name
SAFEWAY INC
Pharmacy Address
SAFEWAY PHARMACY #0239
1601 NORTH PARK DRIVE
WINSLOW, AZ 86047
Pharmacy Comments
Contract Details
Approval Date
4/15/2024
Contract Begin Date
7/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
ANNE NEWLAND, CEO
(928) 522-9564
Contract Pharmacy Representative
Albertsons Companies
Chuck Hanson, Senior 340B Program Manager
(208) 395-6304
Signed By Date
4/15/2024
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