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SAFEWAY PHARMACY #4702
STD90814 One in Long Beach Inc
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Covered Entity Details
Entity Name
One in Long Beach Inc
Subdivision Name
The LGBTQ Center of Long Beach
Type
Sexually Transmitted Diseases
340B ID
STD90814
Entity Address
2017 East 4th Street
Long Beach, CA 90814-1001
Grant Number
1H25PS005127
Participating Start Date
10/1/2017
Last Recertification Date
5/14/2024
Pharmacy Details
Pharmacy Name
SAFEWAY PHARMACY #4702
Pharmacy Address
4550 B ATLANTIC AVENUE
LONG BEACH, CA 90807
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
4/16/2018
Agreement registered in error
Contacts
Covered Entity Signing Official
Porter Gilberg, Executive Director
(562) 434-4455 Ext: 245
Contract Pharmacy Representative
Albertsons Companies
Chuck Hanson, Senior 340B Program Manager
(208) 395-6304
Signed By Date
4/13/2018
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