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SAFEWAY INC
CH09114N SAN MATEO MEDICAL CENTER
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Covered Entity Details
Entity Name
SAN MATEO MEDICAL CENTER
Subdivision Name
COASTSIDE HEALTH CENTER
Type
HRSA-Funded Health Center
340B ID
CH09114N
Entity Address
225 S CABRILLO HIGHWAY, #100A
HALF MOON BAY, CA 94019
Grant Number
H80CS00051
Participating Start Date
10/1/2001
Last Recertification Date
3/5/2025
Pharmacy Details
Pharmacy Name
SAFEWAY INC
Pharmacy Address
SAFEWAY PHARMACY #0964
4950 MISSION ST
SAN FRANCISCO, CA 94112
Pharmacy Comments
Contract Details
Approval Date
4/15/2015
Contract Begin Date
7/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
3/29/2017
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
SUSAN EHRLICH, CEO
(650) 573-2041
Contract Pharmacy Representative
Safeway
Thuy Le, 340B Program Manager
(925) 467-2825
Signed By Date
4/15/2015
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