Contract Pharmacy Details

SAFEWAY INC
CH093030 ADELANTE HEALTHCARE, INC.

Covered Entity Details

Entity Name

ADELANTE HEALTHCARE, INC.

Subdivision Name

Adelante Healthcare

Type

HRSA-Funded Health Center

340B ID

CH093030

Entity Address

3033 N. Central Ave.
Phoenix, AZ 85012-4403

Grant Number

H80CS00140

Participating Start Date

12/1/1992

Last Recertification Date

2/12/2025

Pharmacy Details

Pharmacy Name

SAFEWAY INC

Pharmacy Address

SAFEWAY PHARMACY #1654
4811 N 83RD AVE
PHOENIX, AZ 85033

Pharmacy Comments

Contract Details

Approval Date

10/14/2016

Contract Begin Date

1/1/2017

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

1/7/2025
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Richard Miller, CFO
(623) 583-3001

Contract Pharmacy Representative

Albertsons Companies
Chuck Hanson, Senior 340B Program Manager
(208) 395-6304

Signed By Date

10/14/2016

340B Drug Pricing Program Database