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SAFEWAY INC
CH09289I NORTH COUNTRY HEALTHCARE, INC.
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Covered Entity Details
Entity Name
NORTH COUNTRY HEALTHCARE, INC.
Subdivision Name
NORTH COUNTRY CHC-SELIGMAN SITE
Type
HRSA-Funded Health Center
340B ID
CH09289I
Entity Address
22585 W. OAK STREET
SELIGMAN, AZ 86337-0776
Grant Number
H80CS00651
Participating Start Date
7/1/2010
Last Recertification Date
2/15/2023
Entity Termination Date
4/1/2024
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
Contract Termination Date
Termination Reason
4/1/2024
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Contract Pharmacy Representative
Signed By Date
2/11/2011
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