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SAFEWAY INC
DSH380047 St. Charles Health System, Inc., d/b/a St. Charles Bend
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Covered Entity Details
Entity Name
St. Charles Health System, Inc., d/b/a St. Charles Bend
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH380047
Entity Address
2500 NE NEFF ROAD
BEND, OR 97701
Medicare Provider Number
380047
Participating Start Date
7/1/2016
Last Recertification Date
8/12/2024
Pharmacy Details
Pharmacy Name
SAFEWAY INC
Pharmacy Address
SAFEWAY PHARMACY #1888
320 SW CENTURY DR
BEND, OR 97702-3037
Pharmacy Comments
Contract Details
Approval Date
6/8/2016
Contract Begin Date
7/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/19/2018
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Jennifer Rue Welander, Chief Financial Officer
(541) 706-7707
Contract Pharmacy Representative
Safeway
Thuy Le, 340B Program Manager
(925) 467-2825
Signed By Date
6/8/2016
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