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SAFEWAY INC
CAH501330-00 ASTRIA SUNNYSIDE HOSPITAL
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Covered Entity Details
Entity Name
ASTRIA SUNNYSIDE HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH501330-00
Entity Address
1016 TACOMA AVE
SUNNYSIDE, WA 98944
Medicare Provider Number
501330
Participating Start Date
1/1/2020
Last Recertification Date
8/27/2024
Pharmacy Details
Pharmacy Name
SAFEWAY INC
Pharmacy Address
SAFEWAY PHARMACY #1593
610 E. WINE COUNTRY ROAD
GRANDVIEW, WA 98930
Pharmacy Comments
Contract Details
Approval Date
10/4/2013
Contract Begin Date
1/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2019
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Cary Rowan, CFO
(509) 837-1655
Contract Pharmacy Representative
Safeway
Thuy Le, 340B Program Manager
(925) 467-2825
Signed By Date
10/4/2013
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