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SAFEWAY INC
SCH050352-00 BARTON MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
BARTON MEMORIAL HOSPITAL
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH050352-00
Entity Address
2170 SOUTH AVENUE
SOUTH LAKE TAHOE, CA 96158
Medicare Provider Number
050352
Participating Start Date
7/1/2023
Last Recertification Date
8/20/2024
Pharmacy Details
Pharmacy Name
SAFEWAY INC
Pharmacy Address
SAFEWAY PHARMACY #1537
212 ELKS POINT RD
PO BOX 11111
ZEPHYR COVE, NV 89448
Pharmacy Comments
Contract Details
Approval Date
11/7/2014
Contract Begin Date
1/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
11/7/2017
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
JOHN G. WILLIAMS, CEO
(530) 543-5842
Contract Pharmacy Representative
Safeway
Thuy Le, 340B Program Manager
(925) 467-2825
Signed By Date
11/7/2014
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