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SAFEWAY INC
CH0923660 EL DORADO COUNTY COMMUNITY HEALTH CENTER
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Covered Entity Details
Entity Name
EL DORADO COUNTY COMMUNITY HEALTH CENTER
Subdivision Name
EL DORADO COUNTY COMMUNITY HEALTH CENTER
Type
HRSA-Funded Health Center
340B ID
CH0923660
Entity Address
4212 Missouri Flat Road
Placerville, CA 95667-6269
Grant Number
H80CS06671
Participating Start Date
1/1/2007
Last Recertification Date
2/17/2025
Pharmacy Details
Pharmacy Name
SAFEWAY INC
Pharmacy Address
SAFEWAY PHARMACY #2778
12110 INDUSTRY BLVD.
JACKSON, CA 95642
Pharmacy Comments
Contract Details
Approval Date
7/14/2015
Contract Begin Date
10/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
9/24/2020
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Judy Stein, CFO
(530) 748-2327
Contract Pharmacy Representative
Syed Hashmi, 340B Program Manager
(925) 467-2807
Signed By Date
7/14/2015
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