Contract Pharmacy Details

SAFEWAY INC
CH092890 NORTH COUNTRY HEALTHCARE, INC.

Covered Entity Details

Entity Name

NORTH COUNTRY HEALTHCARE, INC.

Subdivision Name

NORTH COUNTRY - FLAGSTAFF CLINIC

Type

HRSA-Funded Health Center

340B ID

CH092890

Entity Address

2920 N 4th St
Flagstaff, AZ 86004-1816

Grant Number

H80CS00651

Participating Start Date

7/1/1998

Last Recertification Date

2/18/2025

Pharmacy Details

Pharmacy Name

SAFEWAY INC

Pharmacy Address

SAFEWAY PHARMACY #1733
900 W. DEUCE OF CLUBS
SHOW LOW, AZ 85901

Pharmacy Comments

Contract Details

Approval Date

10/15/2012

Contract Begin Date

10/15/2012

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

ANN ROGGENBUCK, CEO
(928) 213-6100 Ext: 2300

Contract Pharmacy Representative

Albertsons Companies
Chuck Hanson, Senior 340B Program Manager
(208) 395-6304

Signed By Date

9/17/2012

340B Drug Pricing Program Database