Contract Pharmacy Details

SAFEWAY INC
CHC24176-00 OLATHE COMMUNITY CLINIC, INC.

Covered Entity Details

Entity Name

OLATHE COMMUNITY CLINIC, INC.

Subdivision Name

Olathe Community Clinic, Inc.

Type

HRSA-Funded Health Center

340B ID

CHC24176-00

Entity Address

308 Main Street
Olathe, CO 81425

Grant Number

H80CS24176

Participating Start Date

4/1/2014

Last Recertification Date

2/14/2025

Pharmacy Details

Pharmacy Name

SAFEWAY INC

Pharmacy Address

SAFEWAY PHARMACY #2625
681 HORIZON DRIVE
GRAND JUNCTION, CO 81506

Pharmacy Comments

Contract Details

Approval Date

4/13/2017

Contract Begin Date

7/1/2017

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

1/7/2020
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Jeremy Carroll, CEO
(970) 263-1701

Contract Pharmacy Representative

Albertsons Companies
Chuck Hanson, Senior 340B Program Manager
(208) 395-6304

Signed By Date

4/13/2017

340B Drug Pricing Program Database