Contract Pharmacy Details

SAFEWAY INC
CH097880 PETALUMA HEALTH CENTER, INC

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 #0918
6340 COMMERCE BLVD
ROHNERT PARK, CA 94928

Pharmacy Comments

Contract Details

Approval Date

10/14/2016

Contract Begin Date

1/1/2017

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Brian Burns, CFO
(707) 559-7588

Contract Pharmacy Representative

Safeway
charles Hanson, 340B program manager
(208) 395-6304

Signed By Date

10/14/2016

340B Drug Pricing Program Database