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SAFEWAY INC
CH09289D NORTH COUNTRY HEALTHCARE, INC.
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Covered Entity Details
Entity Name
NORTH COUNTRY HEALTHCARE, INC.
Subdivision Name
NORTH COUNTRY - HOLBROOK CLINIC
Type
HRSA-Funded Health Center
340B ID
CH09289D
Entity Address
2109 Navajo Blvd
Holbrook, AZ 86025
Grant Number
H80CS00651
Participating Start Date
7/1/2010
Last Recertification Date
2/25/2025
Pharmacy Details
Pharmacy Name
SAFEWAY INC
Pharmacy Address
SAFEWAY PHARMACY #3189
702 WEST HOPI DRIVE
HOLBROOK, AZ 86025
Pharmacy Comments
Contract Details
Approval Date
4/5/2011
Contract Begin Date
4/5/2011
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Contract Pharmacy Representative
Signed By Date
3/11/2011
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