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SAFEWAY INC
CHC29023-00 WINDING WATERS MEDICAL CLINIC
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Covered Entity Details
Entity Name
WINDING WATERS MEDICAL CLINIC
Subdivision Name
Winding Waters Medical Clinic
Type
HRSA-Funded Health Center
340B ID
CHC29023-00
Entity Address
603 MEDICAL PKWY
ENTERPRISE, OR 97828-5124
Grant Number
H80CS29023
Participating Start Date
4/1/2016
Last Recertification Date
2/13/2025
Pharmacy Details
Pharmacy Name
SAFEWAY INC
Pharmacy Address
SAFEWAY PHARMACY #0371
601 W NORTH ST
ENTERPRISE, OR 97828-1427
Pharmacy Comments
Contract Details
Approval Date
1/8/2016
Contract Begin Date
4/1/2016
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Keli Christman, Authorizing Official
(541) 426-4502 Ext: 5933
Contract Pharmacy Representative
Albertsons
Ronald Richmon, Group Director of Managed Care
(630) 948-6285
Signed By Date
1/8/2016
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