Contract Pharmacy Details

SAFEWAY INC
CAH381313-00 St. Charles Health System, Inc., d/b/a St. Charles Prineville

Covered Entity Details

Entity Name

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

Subdivision Name

Type

Critical Access Hospital

340B ID

CAH381313-00

Entity Address

384 SE Combs Flat Road
Prineville, OR 97754

Medicare Provider Number

381313

Participating Start Date

7/1/2012

Last Recertification Date

8/13/2024

Pharmacy Details

Pharmacy Name

SAFEWAY INC

Pharmacy Address

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

Pharmacy Comments

Contract Details

Approval Date

7/8/2017

Contract Begin Date

10/1/2017

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

7/8/2017

340B Drug Pricing Program Database