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SAFEWAY INC
CAH061303-00 EAST MORGAN COUNTY HOSPITAL
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Covered Entity Details
Entity Name
EAST MORGAN COUNTY HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH061303-00
Entity Address
2400 EDISON STREET
BRUSH, CO 80723
Medicare Provider Number
061303
Participating Start Date
9/29/2010
Last Recertification Date
8/20/2024
Pharmacy Details
Pharmacy Name
SAFEWAY INC
Pharmacy Address
SAFEWAY PHARMACY #2918
3526 W 10TH ST
GREELEY, CO 80634
Pharmacy Comments
Contract Details
Approval Date
2/27/2013
Contract Begin Date
4/1/2013
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
3/18/2016
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Dave Kaubisch, Vice President of Finance
(602) 747-4556
Contract Pharmacy Representative
SAFEWAY PHARMACY
Merle Jarvill, Director of Manages Care
(623) 869-4260
Signed By Date
1/11/2013
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