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SAFEWAY INC
CH091940 MENDOCINO COMMUNITY HEALTH CLINIC, INC.
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Covered Entity Details
Entity Name
MENDOCINO COMMUNITY HEALTH CLINIC, INC.
Subdivision Name
Hillside Health Center
Type
HRSA-Funded Health Center
340B ID
CH091940
Entity Address
333 Laws Ave
Ukiah, CA 95482-6540
Grant Number
H80CS00628
Participating Start Date
7/1/1995
Last Recertification Date
2/25/2025
Pharmacy Details
Pharmacy Name
SAFEWAY INC
Pharmacy Address
SAFEWAY PHARMACY #0978
660 SOUTH MAIN STREET
FORT BRAGG, CA 95437
Pharmacy Comments
Contract Details
Approval Date
3/9/2011
Contract Begin Date
3/9/2011
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/25/2016
Agreement registered in error
Contacts
Covered Entity Signing Official
Contract Pharmacy Representative
Signed By Date
2/18/2011
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