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SAFEWAY INC
CH097880 PETALUMA HEALTH CENTER, INC
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Covered Entity Details
Entity Name
PETALUMA HEALTH CENTER, INC
Subdivision Name
Petaluma Health Center
Type
HRSA-Funded Health Center
340B ID
CH097880
Entity Address
1179 N. McDowell Blvd.
Petaluma, CA 94954-6559
Grant Number
H80CS00587
Participating Start Date
7/1/2000
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
SAFEWAY INC
Pharmacy Address
SAFEWAY PHARMACY #3011
389 S. MCDOWELL BLVD
PETALUMA, CA 94954
Pharmacy Comments
01/03/2012 pharmacy update (was Safeway #0796 373 S. McDowell St.)
Contract Details
Approval Date
10/11/2011
Contract Begin Date
10/11/2011
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/5/2016
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
GREG STONE, COO
(707) 490-8600
Contract Pharmacy Representative
SAFEWAY PHARMACY
Merle Jarvill, Director of Manages Care
(623) 869-4260
Signed By Date
9/30/2011
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