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SAFEWAY INC
DSH380051 Salem Health
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Covered Entity Details
Entity Name
Salem Health
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH380051
Entity Address
890 Oak Street SE
Salem, OR 97301
Medicare Provider Number
380051
Participating Start Date
7/1/2012
Last Recertification Date
9/4/2024
Pharmacy Details
Pharmacy Name
SAFEWAY INC
Pharmacy Address
SAFEWAY PHARMACY #1713
22000 SALAMO RD
WEST LINN, OR 97068
Pharmacy Comments
Contract Details
Approval Date
1/11/2017
Contract Begin Date
4/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/3/2018
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
James Parr, Chief Financial Officer
(503) 814-2841
Contract Pharmacy Representative
Albertsons Companies
Chuck Hanson, Senior 340B Program Manager
(208) 395-6304
Signed By Date
1/11/2017
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