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SAFEWAY PHARMACY INC
FQHCLA334AN NEW YORK CITY HEALTH AND HOSPITALS CORPORATION
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Covered Entity Details
Entity Name
NEW YORK CITY HEALTH AND HOSPITALS CORPORATION
Subdivision Name
Morrisania D&TC
Type
Health Center Program Look-Alike
340B ID
FQHCLA334AN
Entity Address
1225 Gerard Ave
Bronx, NY 10452-8001
Grant Number
LALCS00169
Participating Start Date
7/1/2015
Last Recertification Date
2/21/2018
Entity Termination Date
4/1/2019
Pharmacy Details
Pharmacy Name
SAFEWAY PHARMACY INC
Pharmacy Address
493 E 138 STREET
BRONX, NY 10454
Pharmacy Comments
Contract Details
Approval Date
4/13/2018
Contract Begin Date
7/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2019
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Paul Albertson, Vice President
(212) 748-2256
Contract Pharmacy Representative
Safeway
Sagnia Balbuena, OWNER
(718) 585-1071 Ext: 9176648531
Signed By Date
4/13/2018
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