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SAFEWAY INC
CH09114E SAN MATEO MEDICAL CENTER
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Covered Entity Details
Entity Name
SAN MATEO MEDICAL CENTER
Subdivision Name
SEQUOIA TEEN WELLNESS
Type
HRSA-Funded Health Center
340B ID
CH09114E
Entity Address
630 LAUREL STREET
REDWOOD CITY, CA 94063
Grant Number
H80CS00051
Participating Start Date
1/1/2005
Last Recertification Date
2/5/2021
Entity Termination Date
4/1/2022
Pharmacy Details
Pharmacy Name
SAFEWAY INC
Pharmacy Address
SAFEWAY PHARMACY #2719
525 EL CAMINO REAL
MENLO PARK, CA 94025
Pharmacy Comments
Contract Details
Approval Date
4/15/2015
Contract Begin Date
7/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2022
Covered Entity Terminated
Contacts
Covered Entity Signing Official
SUSAN EHRLICH, CEO
(650) 573-2041
Contract Pharmacy Representative
Safeway
Thuy Le, 340B Program Manager
(925) 467-2825
Signed By Date
4/15/2015
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