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SAFEWAY INC
CH09289C NORTH COUNTRY HEALTHCARE, INC.
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Covered Entity Details
Entity Name
NORTH COUNTRY HEALTHCARE, INC.
Subdivision Name
NORTHY COUNTRY - GRAND CANYON SITE
Type
HRSA-Funded Health Center
340B ID
CH09289C
Entity Address
1 CLINIC ROAD
GRAND CANYON, AZ 86023
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 #1747
1031 NORTH HIGHWAY 89
CHINO VALLEY, AZ 86323
Pharmacy Comments
Contract Details
Approval Date
3/9/2011
Contract Begin Date
3/9/2011
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Contract Pharmacy Representative
Signed By Date
2/11/2011
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