Contract Pharmacy Details

SAFEWAY INC
SCH380040-00 St. Charles Health System, Inc., d/b/a St. Charles Redmond

Covered Entity Details

Entity Name

St. Charles Health System, Inc., d/b/a St. Charles Redmond

Subdivision Name

Type

Sole Community Hospital

340B ID

SCH380040-00

Entity Address

1253 NW Canal Blvd
Redmond, OR 97756

Medicare Provider Number

380040

Participating Start Date

7/1/2012

Last Recertification Date

9/9/2020

Entity Termination Date

10/1/2021

Pharmacy Details

Pharmacy Name

SAFEWAY INC

Pharmacy Address

SAFEWAY PHARMACY #4469
246 W MONROE ST
BURNS, OR 97720

Pharmacy Comments

Contract Details

Approval Date

4/10/2017

Contract Begin Date

7/1/2017

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

10/19/2018
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Jennifer Rue Welander, Chief Financial Officer
(541) 706-7707

Contract Pharmacy Representative

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

Signed By Date

4/10/2017

340B Drug Pricing Program Database