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SAFEWAY INC
CAH281357-00 Cheyenne County Hospital Association, Inc. DBA Sidney Regional Medical Center
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Covered Entity Details
Entity Name
Cheyenne County Hospital Association, Inc. DBA Sidney Regional Medical Center
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH281357-00
Entity Address
1000 Pole Creek Crossing
Sidney, NE 69162
Medicare Provider Number
281357
Participating Start Date
1/1/2012
Last Recertification Date
8/21/2024
Pharmacy Details
Pharmacy Name
SAFEWAY INC
Pharmacy Address
SAFEWAY PHARMACY #2555
1944 ILLINOIS STREET
SIDNEY, NE 69162
Pharmacy Comments
Contract Details
Approval Date
7/5/2017
Contract Begin Date
10/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
11/27/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Jason Petik, CEO
(308) 254-5070
Contract Pharmacy Representative
Albertsons Companies
Chuck Hanson, Senior 340B Program Manager
(208) 395-6304
Signed By Date
7/5/2017
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