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SAFEWAY INC
CAH051310-00 Willits Hospital Inc., DBA Adventist Health Howard Memorial
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Covered Entity Details
Entity Name
Willits Hospital Inc., DBA Adventist Health Howard Memorial
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH051310-00
Entity Address
One Marcela Drive
Willits, CA 95490-5769
Medicare Provider Number
051310
Participating Start Date
10/1/2011
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
SAFEWAY INC
Pharmacy Address
SAFEWAY PHARMACY #0965
845 SOUTH MAIN STREET
WILLITS, CA 95490
Pharmacy Comments
Contract Details
Approval Date
8/17/2012
Contract Begin Date
8/17/2012
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
11/1/2015
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
CARLTON Edward JACOBSON, CHIEF FINANCIAL OFFICER
(707) 456-3001
Contract Pharmacy Representative
Safeway
Merle Jarvill, Director, Managed Care
(623) 869-4260
Signed By Date
7/16/2012
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