Contract Pharmacy Details

SAFEWAY INC
RWIID97232 Oregon Health Authority

Covered Entity Details

Entity Name

Oregon Health Authority

Subdivision Name

ADAP / CAREAssist

Type

Ryan White Part B ADAP Direct Purchase

340B ID

RWIID97232

Entity Address

800 NE Oregon St.
Suite 1105
Portland, OR 97232

Grant Number

X07HA00007

Participating Start Date

10/1/2011

Last Recertification Date

2/25/2025

Pharmacy Details

Pharmacy Name

SAFEWAY INC

Pharmacy Address

SAFEWAY PHARMACY #1642
201 SW 20TH ST
PENDLETON, OR 97801-1864

Pharmacy Comments

04/13/2012 changed address (was 203 SW 20TH AVE)

Contract Details

Approval Date

9/27/2011

Contract Begin Date

10/1/2011

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Victor J. Fox, ADAP Manager
(971) 673-0176

Contract Pharmacy Representative

Albertsons Companies
Chuck Hanson, Senior 340B Program Manager
(208) 395-6304

Signed By Date

9/26/2011

340B Drug Pricing Program Database