Contract Pharmacy Details

SAFEWAY INC
CAH381321-00 Grande Ronde Hospital, Inc.

Covered Entity Details

Entity Name

Grande Ronde Hospital, Inc.

Subdivision Name

Type

Critical Access Hospital

340B ID

CAH381321-00

Entity Address

900 Sunset Drive
La Grande, OR 97850

Medicare Provider Number

381321

Participating Start Date

4/1/2013

Last Recertification Date

8/20/2024

Pharmacy Details

Pharmacy Name

SAFEWAY INC

Pharmacy Address

SAFEWAY PHARMACY #1827
2111 ADAMS AVENUE
LA GRANDE, OR 97850

Pharmacy Comments

Contract Details

Approval Date

4/1/2015

Contract Begin Date

7/1/2015

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Wade E. Weis, Sr. Director of Finance/CFO
(541) 963-1463

Contract Pharmacy Representative

SAFEWAY PHARMACY
Snehal Doshi, Group Director of Managed Care
(925) 467-2843

Signed By Date

4/1/2015

340B Drug Pricing Program Database