Contract Pharmacy Details

SAFEWAY INC
CAH501320-00 QUINCY VALLEY MEDICAL CENTER

Covered Entity Details

Entity Name

QUINCY VALLEY MEDICAL CENTER

Subdivision Name

Type

Critical Access Hospital

340B ID

CAH501320-00

Entity Address

908 10TH AVENUE SW
QUINCY, WA 98848

Medicare Provider Number

501320

Participating Start Date

4/1/2017

Last Recertification Date

11/17/2017

Entity Termination Date

10/1/2018

Pharmacy Details

Pharmacy Name

SAFEWAY INC

Pharmacy Address

SAFEWAY PHARMACY #1544
1150 BASIN STREET SW
EPHRATA, WA 98823

Pharmacy Comments

Contract Details

Approval Date

4/16/2013

Contract Begin Date

7/1/2013

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

10/1/2016

Contacts

Covered Entity Signing Official

Mehdi Merred, CEO
(509) 787-5346

Contract Pharmacy Representative

THE VONS COMPANIES INC
Matt Vian, 340B Program Administrator
(623) 869-3454

Signed By Date

4/16/2013

340B Drug Pricing Program Database