Contract Pharmacy Details

SAFEWAY INC
FP96749 BAY CLINIC INC

Covered Entity Details

Entity Name

BAY CLINIC INC

Subdivision Name

Kea'au Family Health and Dental Center

Type

Family Planning (Title X only)

340B ID

FP96749

Entity Address

16-192 Pili Mua Street
Kea'au, HI 96749

Grant Number

FPHPA090326

Participating Start Date

4/1/2007

Last Recertification Date

5/9/2022

Entity Termination Date

7/1/2023

Pharmacy Details

Pharmacy Name

SAFEWAY INC

Pharmacy Address

SAFEWAY PHARMACY #2893
381 EAST MAKAALA STREET
HILO, HI 96720

Pharmacy Comments

Contract Details

Approval Date

7/3/2019

Contract Begin Date

10/1/2019

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

7/9/2019
Agreement registered in error

Contacts

Covered Entity Signing Official

Youlsau Bells, Interim Chief Executive Officer
(808) 961-4078

Contract Pharmacy Representative

Albertsons Companies
Chuck Hanson, Senior 340B Program Manager
(208) 395-6304

Signed By Date

7/3/2019

340B Drug Pricing Program Database