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SAFEWAY INC
CHC24160-00 Neighborhood Health Center
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Covered Entity Details
Entity Name
Neighborhood Health Center
Subdivision Name
NHC Administration and Pharmacy
Type
HRSA-Funded Health Center
340B ID
CHC24160-00
Entity Address
7320 SW Hunziker Rd STE 300
Portland, OR 97223
Grant Number
H80CS24160
Participating Start Date
1/1/2015
Last Recertification Date
2/19/2025
Pharmacy Details
Pharmacy Name
SAFEWAY INC
Pharmacy Address
SAFEWAY PHARMACY #1478
15570 SW PACIFIC HWY
TIGARD, OR 97224
Pharmacy Comments
Contract Details
Approval Date
7/26/2017
Contract Begin Date
10/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/9/2018
Contacts
Covered Entity Signing Official
Blain A. West, CFO / COO
(503) 941-3028
Contract Pharmacy Representative
SAFEWAY
Charles Hanson, 340B Program Manager
(208) 395-6304
Signed By Date
7/26/2017
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