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SAFEWAY INC
DSH290001 RENOWN REGIONAL MEDICAL CENTER
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Covered Entity Details
Entity Name
RENOWN REGIONAL MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH290001
Entity Address
1155 MILL STREET
RENO, NV 89502-1474
Medicare Provider Number
290001
Participating Start Date
4/1/2009
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
SAFEWAY INC
Pharmacy Address
SAFEWAY PHARMACY #1210
5150 MAE ANNE AVE #300
RENO, NV 89523
Pharmacy Comments
Contract Details
Approval Date
4/5/2013
Contract Begin Date
7/1/2013
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/7/2017
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Dawn Ahner, EVP & Chief Administrative Officer
(775) 982-4404
Contract Pharmacy Representative
Safeway
Thuy Le, 340B Program Manager
(925) 467-2825
Signed By Date
4/5/2013
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