340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
SAFEWAY INC
CAH031300-00 WICKENBURG COMMUNITY HOSPITAL ASSOCIATION INC
Print
Covered Entity Details
Entity Name
WICKENBURG COMMUNITY HOSPITAL ASSOCIATION INC
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH031300-00
Entity Address
520 ROSE LANE
WICKENBURG, AZ 85390
Medicare Provider Number
031300
Participating Start Date
4/1/2012
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
SAFEWAY INC
Pharmacy Address
SAFEWAY PHARMACY #1997
17049 W BELL RD
SURPRISE, AZ 85374
Pharmacy Comments
Contract Details
Approval Date
1/12/2018
Contract Begin Date
4/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/11/2018
Covered Entity Terminated
Contacts
Covered Entity Signing Official
JIM TAVARY, C.E.O.
(928) 684-4362
Contract Pharmacy Representative
Albertsons Companies
Chuck Hanson, Senior 340B Program Manager
(208) 395-6304
Signed By Date
1/12/2018
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session