Contract Pharmacy Details

SAFEWAY INC
CAH501308-00 Douglas, Grant, Lincoln, Okanogan Counties Public Hospital District #6

Covered Entity Details

Entity Name

Douglas, Grant, Lincoln, Okanogan Counties Public Hospital District #6

Subdivision Name

Coulee Medical Center

Type

Critical Access Hospital

340B ID

CAH501308-00

Entity Address

411 Fortuyn Road
Grand Coulee, WA 99133

Medicare Provider Number

501308

Participating Start Date

10/1/2013

Last Recertification Date

8/19/2024

Pharmacy Details

Pharmacy Name

SAFEWAY INC

Pharmacy Address

SAFEWAY PHARMACY #3247
101 GRAND COULEE HWY
PO BOX 50
GRAND COULEE, WA 99133

Pharmacy Comments

Contract Details

Approval Date

4/14/2014

Contract Begin Date

7/1/2014

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

9/29/2021
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Alan Wagner, Chief Operating Officer
(509) 633-6362

Contract Pharmacy Representative

Safeway
Thuy Le, 340B Program Manager
(925) 467-2825

Signed By Date

4/14/2014

340B Drug Pricing Program Database