Contract Pharmacy Details

SAFEWAY INC
DSH380047 St. Charles Health System, Inc., d/b/a St. Charles Bend

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 #4469
246 W MONROE ST
BURNS, OR 97720

Pharmacy Comments

Contract Details

Approval Date

1/18/2017

Contract Begin Date

4/1/2017

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

ShopKo
Lorie Neumann, Contracting & Compliance
(920) 429-4726

Signed By Date

1/18/2017

340B Drug Pricing Program Database