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SAFEWAY INC
CH09289M NORTH COUNTRY HEALTHCARE, INC.
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Covered Entity Details
Entity Name
NORTH COUNTRY HEALTHCARE, INC.
Subdivision Name
NORTH COUNTRY HEALTHCARE- WILLIAMS
Type
HRSA-Funded Health Center
340B ID
CH09289M
Entity Address
300 S 6th St
Williams, AZ 86046
Grant Number
H80CS00651
Participating Start Date
4/1/2011
Last Recertification Date
2/23/2025
Pharmacy Details
Pharmacy Name
SAFEWAY INC
Pharmacy Address
SAFEWAY PHARMACY #1639
637 W ROUTE 66
WILLIAMS, AZ 86046
Pharmacy Comments
Contract Details
Approval Date
4/5/2011
Contract Begin Date
4/5/2011
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Contract Pharmacy Representative
Signed By Date
3/11/2011
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