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SAFEWAY INC
CH0910250 MENDOCINO COAST CLINICS, INC.
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Covered Entity Details
Entity Name
MENDOCINO COAST CLINICS, INC.
Subdivision Name
MENDOCINO COAST CLINICS, INC.
Type
HRSA-Funded Health Center
340B ID
CH0910250
Entity Address
205 South St
Fort Bragg, CA 95437-5540
Grant Number
H80CS00876
Participating Start Date
1/1/2001
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
SAFEWAY INC
Pharmacy Address
SAFEWAY PHARMACY #0978
660 SOUTH MAIN STREET
FORT BRAGG, CA 95437
Pharmacy Comments
Contract Details
Approval Date
12/10/2010
Contract Begin Date
12/10/2010
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Paula Cohen, Executive Director
(707) 961-3431
Contract Pharmacy Representative
Safeway
Merle Jarvill, Director, Managed Care
(623) 869-4260
Signed By Date
12/8/2010
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