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SAFEWAY INC
CH09114L SAN MATEO MEDICAL CENTER
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Covered Entity Details
Entity Name
SAN MATEO MEDICAL CENTER
Subdivision Name
FAIR OAKS FAMILY HEALTH CENTER
Type
HRSA-Funded Health Center
340B ID
CH09114L
Entity Address
2710 MIDDLEFIELD ROAD
REDWOOD CITY, CA 94063
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 #0747
850 WOODSIDE ROAD
REDWOOD CITY, CA 94061
Pharmacy Comments
Contract Details
Approval Date
4/15/2015
Contract Begin Date
7/1/2015
Carve-In Effective Date
Contract Comments
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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