Contract Pharmacy Details

SAFEWAY INC
DSH050599 UNIVERSITY OF CALIFORNIA DAVIS MEDICAL CENTER

Covered Entity Details

Entity Name

UNIVERSITY OF CALIFORNIA DAVIS MEDICAL CENTER

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH050599

Entity Address

2315 STOCKTON BLVD
SACRAMENTO, CA 95817

Medicare Provider Number

050599

Participating Start Date

1/1/1999

Last Recertification Date

8/22/2024

Pharmacy Details

Pharmacy Name

SAFEWAY INC

Pharmacy Address

SAFEWAY PHARMACY #2778
12110 INDUSTRY BLVD.
JACKSON, CA 95642

Pharmacy Comments

Contract Details

Approval Date

1/15/2015

Contract Begin Date

4/1/2015

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

11/18/2024
Covered Entity Terminated

Contacts

Covered Entity Signing Official

TIMOTHY MAURICE, CHIEF FINANCIAL OFFICER
(916) 734-4055

Contract Pharmacy Representative

Albertsons Companies
Chuck Hanson, Senior 340B Program Manager
(208) 395-6304

Signed By Date

1/15/2015

340B Drug Pricing Program Database