Contract Pharmacy Details

SAFEWAY INC
CHC24176-03 Olathe Community Clinic, Inc.

Covered Entity Details

Entity Name

Olathe Community Clinic, Inc.

Subdivision Name

River Valley Family Health Center of Montrose

Type

HRSA-Funded Health Center

340B ID

CHC24176-03

Entity Address

1010 Rio Grande Avenue
Montrose, CO 81401

Grant Number

H80CS24176

Participating Start Date

7/1/2018

Last Recertification Date

2/14/2025

Pharmacy Details

Pharmacy Name

SAFEWAY INC

Pharmacy Address

SAFEWAY PHARMACY #1863
1550 HIGHWAY 92
DELTA, CO 81416

Pharmacy Comments

Contract Details

Approval Date

4/19/2018

Contract Begin Date

7/1/2018

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Jeremy Carroll, CEO
(970) 263-1701

Contract Pharmacy Representative

Safeway
Thuy Le, 340B Program Manager
(925) 467-2825

Signed By Date

4/16/2018

340B Drug Pricing Program Database