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SAFEWAY INC
CAH061323-00 PROWERS MEDICAL CENTER
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Covered Entity Details
Entity Name
PROWERS MEDICAL CENTER
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH061323-00
Entity Address
401 KENDALL DRIVE
LAMAR, CO 81052
Medicare Provider Number
061323
Participating Start Date
1/1/2011
Last Recertification Date
8/14/2024
Pharmacy Details
Pharmacy Name
SAFEWAY INC
Pharmacy Address
SAFEWAY PHARMACY #1721
906 E. OLIVE STREET
LAMAR, CO 81052
Pharmacy Comments
Contract Details
Approval Date
12/3/2012
Contract Begin Date
1/1/2013
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/27/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Audrey Kane, CFO
(719) 336-6753
Contract Pharmacy Representative
Albertsons Companies
Chuck Hanson, Senior 340B Program Manager
(208) 395-6304
Signed By Date
10/12/2012
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