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SAFEWAY INC
FQHC638013 PIT RIVER HEALTH SERVICES
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Covered Entity Details
Entity Name
PIT RIVER HEALTH SERVICES
Subdivision Name
Type
Tribal Contract/Compact with IHS (P.L. 93-638)
340B ID
FQHC638013
Entity Address
36977 PARK AVE.
BURNEY, CA 96013
Grant Number
Participating Start Date
7/1/2014
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
SAFEWAY INC
Pharmacy Address
SAFEWAY PHARMACY #4178
37264 MAIN STREET
BURNEY, CA 96013
Pharmacy Comments
Contract Details
Approval Date
7/31/2014
Contract Begin Date
7/31/2014
Carve-In Effective Date
Contract Comments
07/31/2014 Immediate Contract begin date authorized
Contacts
Covered Entity Signing Official
Deven Parlikar, Executive Director
(530) 335-5090 Ext: 130
Contract Pharmacy Representative
Safeway
Thuy Le, 340B Program Manager
(925) 467-2825
Signed By Date
7/31/2014
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