340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
SAFEWAY INC
DSH050122 DAMERON HOSPITAL ASSOCIATION
Print
Covered Entity Details
Entity Name
DAMERON HOSPITAL ASSOCIATION
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH050122
Entity Address
525 WEST ACACIA STREET
STOCKTON, CA 95203
Medicare Provider Number
050122
Participating Start Date
10/1/2006
Last Recertification Date
9/6/2024
Pharmacy Details
Pharmacy Name
SAFEWAY INC
Pharmacy Address
SAFEWAY PHARMACY #1648
2449 W KETTLEMAN LANE
LODI, CA 95242
Pharmacy Comments
Contract Details
Approval Date
10/14/2019
Contract Begin Date
1/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/16/2020
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Denise Hair, CNO
(209) 461-3133
Contract Pharmacy Representative
SAFEWAY
Charles Hanson, 340B Program Manager
(208) 395-6304
Signed By Date
10/14/2019
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session