340B Drug Pricing Program Database
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SAFEWAY INC
CAH381323-00 MID-VALLEY HEALTHCARE, INC. DBA SAMARITAN LEBANON COMMUNITY HOSPITAL
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Covered Entity Details
Entity Name
MID-VALLEY HEALTHCARE, INC. DBA SAMARITAN LEBANON COMMUNITY HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH381323-00
Entity Address
525 N. SANTIAM HWY
LEBANON, OR 97355
Medicare Provider Number
381323
Participating Start Date
8/4/2010
Last Recertification Date
8/23/2024
Pharmacy Details
Pharmacy Name
SAFEWAY INC
Pharmacy Address
SAFEWAY PHARMACY #1558
1983 S MAIN ST
LEBANON, OR 97355
Pharmacy Comments
Contract Details
Approval Date
6/20/2012
Contract Begin Date
6/20/2012
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
9/9/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Dan Smith, Chief Financial Officer
(541) 768-5390
Contract Pharmacy Representative
Safeway
charles Hanson, 340B program manager
(208) 395-6304
Signed By Date
5/23/2012
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