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SAFEWAY INC
CH10252C Seattle Roots Community Health
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Covered Entity Details
Entity Name
Seattle Roots Community Health
Subdivision Name
Seattle Roots Dental Clinic
Type
HRSA-Funded Health Center
340B ID
CH10252C
Entity Address
510 19th Ave E
Seattle, WA 98112-4007
Grant Number
H80CS00647
Participating Start Date
4/1/2019
Last Recertification Date
2/26/2025
Pharmacy Details
Pharmacy Name
SAFEWAY INC
Pharmacy Address
SAFEWAY PHARMACY #1551
1410 E JOHN ST
SEATTLE, WA 98112
Pharmacy Comments
Contract Details
Approval Date
4/15/2024
Contract Begin Date
7/1/2024
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/15/2024
Agreement registered in error
Contacts
Covered Entity Signing Official
Bessie Chi, Director of Pharmacy
(206) 709-7116
Contract Pharmacy Representative
CVS
Erica Short, Account Manager
(480) 364-1195
Signed By Date
4/15/2024
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