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SAFEWAY INC
FQHC638024 UNITED INDIAN HEALTH SERVICES
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Covered Entity Details
Entity Name
UNITED INDIAN HEALTH SERVICES
Subdivision Name
POTAWAT CLINIC
Type
Tribal Contract/Compact with IHS (P.L. 93-638)
340B ID
FQHC638024
Entity Address
1600 WEEOT WAY
ARCATA, CA 95521
Grant Number
Participating Start Date
1/1/1995
Last Recertification Date
3/3/2025
Pharmacy Details
Pharmacy Name
SAFEWAY INC
Pharmacy Address
SAFEWAY PHARMACY #0954
475 M STREET
CRESCENT CITY, CA 95531
Pharmacy Comments
Contract Details
Approval Date
10/14/2013
Contract Begin Date
1/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/31/2018
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Richard Baland, CFO
(707) 825-4065
Contract Pharmacy Representative
Safeway
Thuy Le, 340B Program Manager
(925) 467-2825
Signed By Date
10/14/2013
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