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SAFEWAY INC
CAH381320-00 Columbia Lutheran Charities DBA Columbia Memorial Hospital
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Covered Entity Details
Entity Name
Columbia Lutheran Charities DBA Columbia Memorial Hospital
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH381320-00
Entity Address
2111 Exchange Street
Astoria, OR 97103-3329
Medicare Provider Number
381320
Participating Start Date
10/1/2011
Last Recertification Date
8/20/2024
Pharmacy Details
Pharmacy Name
SAFEWAY INC
Pharmacy Address
SAFEWAY PHARMACY #2627
3250 LEIF ERICKSON DRIVE
ASTORIA, OR 97103
Pharmacy Comments
Contract Details
Approval Date
7/11/2012
Contract Begin Date
7/15/2012
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
9/1/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
William Guy Rivers, Chief Financial Officer
(503) 338-4002
Contract Pharmacy Representative
Albertsons Companies
Chuck Hanson, Senior 340B Program Manager
(208) 395-6304
Signed By Date
7/4/2012
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