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SAFEWAY INC
DSH050225 Adventist Health Feather River
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Covered Entity Details
Entity Name
Adventist Health Feather River
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH050225
Entity Address
5974 PENTZ ROAD
PARADISE, CA 95969
Medicare Provider Number
050225
Participating Start Date
10/1/2010
Last Recertification Date
8/30/2018
Entity Termination Date
7/1/2019
Pharmacy Details
Pharmacy Name
SAFEWAY INC
Pharmacy Address
SAFEWAY PHARMACY #1125
1366 EAST AVE
CHICO, CA 95926
Pharmacy Comments
Contract Details
Approval Date
10/23/2013
Contract Begin Date
1/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2019
Covered Entity Terminated
Contacts
Covered Entity Signing Official
DANIEL K. GORDON, VP FINANCE/CFO
(530) 876-7200
Contract Pharmacy Representative
Safeway
Thuy Le, 340B Program Manager
(925) 467-2825
Signed By Date
10/23/2013
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