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SAFEWAY INC
CAH501312-00 PROSSER MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
PROSSER MEMORIAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH501312-00
Entity Address
200 Prosser Health Drive
PROSSER, WA 99350
Medicare Provider Number
501312
Participating Start Date
4/1/2019
Last Recertification Date
8/28/2024
Pharmacy Details
Pharmacy Name
SAFEWAY INC
Pharmacy Address
SAFEWAY PHARMACY #0584
711 W 1ST AVE
TOPPENISH, WA 98948
Pharmacy Comments
Contract Details
Approval Date
1/18/2017
Contract Begin Date
4/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2018
Covered Entity Terminated
Contacts
Covered Entity Signing Official
TIM COOPER, CFO
(509) 786-2222 Ext: 6051
Contract Pharmacy Representative
Albertsons Companies
Chuck Hanson, Senior 340B Program Manager
(208) 395-6304
Signed By Date
1/18/2017
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