Contract Pharmacy Details

ALBERTSON'S LLC
CH093030 ADELANTE HEALTHCARE, INC.

Covered Entity Details

Entity Name

ADELANTE HEALTHCARE, INC.

Subdivision Name

Adelante Healthcare

Type

HRSA-Funded Health Center

340B ID

CH093030

Entity Address

3033 N. Central Ave.
Phoenix, AZ 85012-4403

Grant Number

H80CS00140

Participating Start Date

12/1/1992

Last Recertification Date

2/12/2025

Pharmacy Details

Pharmacy Name

ALBERTSON'S LLC

Pharmacy Address

OSCO DRUG #977
14551 WEST GRAND AVENUE
SURPRISE, AZ 85374

Pharmacy Comments

Contract Details

Approval Date

10/15/2018

Contract Begin Date

1/1/2019

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

1/7/2025
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Eric Battis, COO
(623) 583-3001 Ext: 1222

Contract Pharmacy Representative

Albertsons Companies
Chuck Hanson, Senior 340B Program Manager
(208) 395-6304

Signed By Date

10/15/2018

340B Drug Pricing Program Database