Contract Pharmacy Details

SAFEWAY INC
FQHCLA225 Maricopa County Special Health Care District

Covered Entity Details

Entity Name

Maricopa County Special Health Care District

Subdivision Name

Type

Health Center Program Look-Alike

340B ID

FQHCLA225

Entity Address

2601 E. ROOSEVELT STREET
PHOENIX, AZ 85008

Grant Number

LALCS00037

Participating Start Date

10/1/2007

Last Recertification Date

2/15/2019

Entity Termination Date

4/1/2020

Pharmacy Details

Pharmacy Name

SAFEWAY INC

Pharmacy Address

SAFEWAY PHARMACY #2042
3132 E CAMELBACK RD
PHOENIX, AZ 85016

Pharmacy Comments

Contract Details

Approval Date

4/17/2017

Contract Begin Date

7/1/2017

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

4/1/2020
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Kris Gaw, Chief Operating Officer
(602) 344-1258

Contract Pharmacy Representative

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

Signed By Date

4/17/2017

340B Drug Pricing Program Database