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SAFEWAY PHARMACY #4532
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 PHARMACY #4532
Pharmacy Address
90 S MAIN ST
WILLITS, CA 95490
Pharmacy Comments
Contract Details
Approval Date
7/12/2013
Contract Begin Date
7/22/2013
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
Brandon Parker, CFO
(707) 462-3111 Ext: 1600
Contract Pharmacy Representative
Safeway
Thuy Le, 340B Program Manager
(925) 467-2825
Signed By Date
7/12/2013
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