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SAFEWAY INC
DSH060107 NATIONAL JEWISH MEDICAL AND RESEARCH CENTER
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Covered Entity Details
Entity Name
NATIONAL JEWISH MEDICAL AND RESEARCH CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH060107
Entity Address
1400 JACKSON STREET
DENVER, CO 80206
Medicare Provider Number
060107
Participating Start Date
10/1/2004
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
SAFEWAY INC
Pharmacy Address
SAFEWAY PHARMACY #2714
6220 EAST 14TH AVENUE
DENVER, CO 80220
Pharmacy Comments
Contract Details
Approval Date
10/13/2016
Contract Begin Date
1/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/27/2019
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
CHRISTINE FORKNER, CFO
(303) 398-1004
Contract Pharmacy Representative
Albertsons Companies
Chuck Hanson, Senior 340B Program Manager
(208) 395-6304
Signed By Date
10/13/2016
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