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 #2790
1303 NW LOVEJOY ST
PORTLAND, OR 97209

Pharmacy Comments

Contract Details

Approval Date

4/17/2013

Contract Begin Date

7/1/2013

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

9/1/2016
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

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

Contract Pharmacy Representative

THE VONS COMPANIES INC
Matt Vian, 340B Program Administrator
(623) 869-3454

Signed By Date

4/17/2013

340B Drug Pricing Program Database