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SAFEWAY INC
CAH381312-00 COQUILLE VALLEY HOSPITAL DISTRICT
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Covered Entity Details
Entity Name
COQUILLE VALLEY HOSPITAL DISTRICT
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH381312-00
Entity Address
940 E. 5th Street
COQUILLE, OR 97423
Medicare Provider Number
381312
Participating Start Date
4/1/2018
Last Recertification Date
8/13/2024
Pharmacy Details
Pharmacy Name
SAFEWAY INC
Pharmacy Address
SAFEWAY PHARMACY #4262
3 EAST FIRST STREET
COQUILLE, OR 97423
Pharmacy Comments
Contract Details
Approval Date
1/10/2018
Contract Begin Date
4/1/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jeffrey M. Lang, CEO
(541) 396-1052
Contract Pharmacy Representative
Albertsons Companies
Chuck Hanson, Senior 340B Program Manager
(208) 395-6304
Signed By Date
1/3/2018
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