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SAFEWAY INC
FQHC638012 NORTHERN VALLEY INDIAN HEALTH
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Covered Entity Details
Entity Name
NORTHERN VALLEY INDIAN HEALTH
Subdivision Name
Type
Tribal Contract/Compact with IHS (P.L. 93-638)
340B ID
FQHC638012
Entity Address
207 N BUTTE STREET
WILLOWS, CA 95988
Grant Number
Participating Start Date
1/1/1995
Last Recertification Date
2/18/2025
Pharmacy Details
Pharmacy Name
SAFEWAY INC
Pharmacy Address
SAFEWAY PHARMACY #1125
1366 EAST AVE
CHICO, CA 95926
Pharmacy Comments
Contract Details
Approval Date
4/11/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
2/1/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
INDER WADHWA, CHIEF EXECUTIVE OFFICER
(530) 896-9409
Contract Pharmacy Representative
Albertsons Companies
Chuck Hanson, Senior 340B Program Manager
(208) 395-6304
Signed By Date
4/11/2019
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