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SAFEWAY INC
DSH050590 METHODIST HOSPITAL OF SACRAMENTO
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Covered Entity Details
Entity Name
METHODIST HOSPITAL OF SACRAMENTO
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH050590
Entity Address
7500 HOSPITAL DRIVE
SACRAMENTO, CA 95823
Medicare Provider Number
050590
Participating Start Date
4/1/2005
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
SAFEWAY INC
Pharmacy Address
SAFEWAY PHARMACY #2242
1025 ALHAMBRA BLVD
SACRAMENTO, CA 95816
Pharmacy Comments
Contract Details
Approval Date
3/21/2013
Contract Begin Date
4/1/2013
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
8/1/2016
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Bonnie Helen Jenkins, CFO
(916) 453-4459
Contract Pharmacy Representative
THE VONS COMPANIES INC
Matt Vian, 340B Program Administrator
(623) 869-3454
Signed By Date
1/15/2013
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