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SAFEWAY INC
FQHCLA328 SAN JOAQUIN, COUNTY OF
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Covered Entity Details
Entity Name
SAN JOAQUIN, COUNTY OF
Subdivision Name
Primary Medicine Clinic
Type
Health Center Program Look-Alike
340B ID
FQHCLA328
Entity Address
500 W. Hospital Rd
Suite C
French Camp, CA 95231-9693
Grant Number
LALCS00158
Participating Start Date
10/1/2014
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
SAFEWAY INC
Pharmacy Address
SAFEWAY PHARMACY #1769
2808 COUNTRY CLUB BLVD
STOCKTON, CA 95204
Pharmacy Comments
Contract Details
Approval Date
4/14/2020
Contract Begin Date
6/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Farhan Fadoo, Chief Executive Officer
(209) 953-3700
Contract Pharmacy Representative
340BDirect
Thuy Le, Vice President Pharmacy Account Management
(801) 326-3150
Signed By Date
4/14/2020
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