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ALBERTSONS LLC
CH10792N COUNTY OF LANE
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Covered Entity Details
Entity Name
COUNTY OF LANE
Subdivision Name
Brookside Clinic
Type
HRSA-Funded Health Center
340B ID
CH10792N
Entity Address
1680 Chambers Street STE 103
Eugene, OR 97402-3655
Grant Number
H80CS01443
Participating Start Date
1/1/2015
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
ALBERTSONS LLC
Pharmacy Address
SAV-ON PHARMACY #574
5755 MAIN ST
SPRINGFIELD, OR 97478
Pharmacy Comments
Contract Details
Approval Date
10/8/2017
Contract Begin Date
1/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/9/2018
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Karen Gaffney, DIRECTOR, HEALTH & HUMAN SERVICES
(541) 682-3942
Contract Pharmacy Representative
Albertsons Companies
Chuck Hanson, Senior 340B Program Manager
(208) 395-6304
Signed By Date
10/8/2017
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