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SAFEWAY INC
CH09047L GOLDEN VALLEY HEALTH CENTERS
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Covered Entity Details
Entity Name
GOLDEN VALLEY HEALTH CENTERS
Subdivision Name
GHVC - MODESTO FLORIDA SUITES
Type
HRSA-Funded Health Center
340B ID
CH09047L
Entity Address
1510 Florida Ave
Modesto, CA 95350-4437
Grant Number
H80CS00742
Participating Start Date
7/1/1999
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
SAFEWAY INC
Pharmacy Address
SAFEWAY PHARMACY #1661
2001 MCHENRY AVENUE
MODESTO, CA 95350
Pharmacy Comments
Contract Details
Approval Date
12/31/2009
Contract Begin Date
12/31/2009
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Christine Noguera, Interim CEO
(209) 385-5548
Contract Pharmacy Representative
Safeway
Merle Jarvill, Director, Managed Care
(623) 869-4260
Signed By Date
12/17/2009
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