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SAFEWAY INC
DSH050009 ST Joseph Health Northern California LLC-DBA Queen of the Valley Medical Center
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Covered Entity Details
Entity Name
ST Joseph Health Northern California LLC-DBA Queen of the Valley Medical Center
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH050009
Entity Address
1000 TRANCAS STREET
NAPA, CA 94558
Medicare Provider Number
050009
Participating Start Date
4/1/2016
Last Recertification Date
8/16/2024
Pharmacy Details
Pharmacy Name
SAFEWAY INC
Pharmacy Address
SAFEWAY PHARMACY #2449
3375 JEFFERSON STREET
NAPA, CA 94558
Pharmacy Comments
Contract Details
Approval Date
1/25/2021
Contract Begin Date
4/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
9/29/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Patti Pilgrim, Regional CFO
(707) 525-5323
Contract Pharmacy Representative
Albertsons Companies
Chuck Hanson, Senior 340B Program Manager
(208) 395-6304
Signed By Date
1/25/2021
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