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SAFEWAY INC
DSH050367 NorthBay Healthcare Group
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Covered Entity Details
Entity Name
NorthBay Healthcare Group
Subdivision Name
NORTH BAY MEDICAL CENTER
Type
Disproportionate Share Hospital
340B ID
DSH050367
Entity Address
1200 B GALE WILSON BLVD
FAIRFIELD, CA 94533
Medicare Provider Number
050367
Participating Start Date
7/1/2005
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
SAFEWAY INC
Pharmacy Address
SAFEWAY PHARMACY #1127
2401 WATERMAN BLVD
FAIRFIELD, CA 94533
Pharmacy Comments
Contract Details
Approval Date
1/3/2022
Contract Begin Date
1/3/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Michele Bouit, VP Finance and CFO
(707) 646-3111
Contract Pharmacy Representative
NorthBay Healthcare Group
RYAN SEO, DIRECTOR OF PHARMACY
(707) 646-4290
Signed By Date
1/3/2022
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