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SAFEWAY INC
FQHC638483 MACT Health Board, Inc.
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Covered Entity Details
Entity Name
MACT Health Board, Inc.
Subdivision Name
MACT Medical, Jackson
Type
Tribal Contract/Compact with IHS (P.L. 93-638)
340B ID
FQHC638483
Entity Address
12140 NEW YORK RANCH ROAD
JACKSON, CA 95642
Grant Number
Participating Start Date
1/1/2003
Last Recertification Date
2/18/2025
Pharmacy Details
Pharmacy Name
SAFEWAY INC
Pharmacy Address
SAFEWAY PHARMACY #2778
12110 INDUSTRY BLVD.
JACKSON, CA 95642
Pharmacy Comments
Contract Details
Approval Date
7/23/2009
Contract Begin Date
7/23/2009
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
NANCY L. EHLERS, CEO/CHAIMAN M.A.C.I. HEALTH BOARD
(209) 754-6262
Contract Pharmacy Representative
Albertsons Companies
Chuck Hanson, Senior 340B Program Manager
(208) 395-6304
Signed By Date
6/30/2009
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