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SAFEWAY INC
CH084100 HIGH PLAINS COMMUNITY HEALTH CENTER
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Covered Entity Details
Entity Name
HIGH PLAINS COMMUNITY HEALTH CENTER
Subdivision Name
HIGH PLAINS COMMUNITY HEALTH CENTER
Type
HRSA-Funded Health Center
340B ID
CH084100
Entity Address
201 Kendall Dr
Lamar, CO 81052-3939
Grant Number
H80CS00214
Participating Start Date
7/1/1997
Last Recertification Date
2/25/2025
Pharmacy Details
Pharmacy Name
SAFEWAY INC
Pharmacy Address
SAFEWAY PHARMACY #1721
906 E. OLIVE STREET
LAMAR, CO 81052
Pharmacy Comments
Contract Details
Approval Date
5/27/2010
Contract Begin Date
5/27/2010
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jay Brooke, Executive Director
(719) 336-0261
Contract Pharmacy Representative
Safeway
Merle Jarvill, Director, Managed Care
(623) 869-4260
Signed By Date
5/14/2010
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