Contract Pharmacy Details

FRY'S FOOD & DRUG #674
CH09303E ADELANTE HEALTHCARE, INC.

Covered Entity Details

Entity Name

ADELANTE HEALTHCARE, INC.

Subdivision Name

Adelante Healthcare Surprise

Type

HRSA-Funded Health Center

340B ID

CH09303E

Entity Address

15351 W. Bell Road
Surprise, AZ 85374

Grant Number

H80CS00140

Participating Start Date

4/1/1999

Last Recertification Date

2/12/2025

Pharmacy Details

Pharmacy Name

FRY'S FOOD & DRUG #674

Pharmacy Address

13982 W. WADDELL ROAD
SURPRISE, AZ 85379

Pharmacy Comments

Contract Details

Approval Date

6/16/2011

Contract Begin Date

6/21/2011

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

9/29/2017
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Contract Pharmacy Representative

Signed By Date

340B Drug Pricing Program Database