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AZ PHARMACY, LLC
CH09303N Adelante Healthcare, Inc.
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Covered Entity Details
Entity Name
Adelante Healthcare, Inc.
Subdivision Name
Adelante Healthcare
Type
HRSA-Funded Health Center
340B ID
CH09303N
Entity Address
3033 N Central Ave
Phoenix, AZ 85012-2809
Grant Number
H80CS00140
Participating Start Date
4/1/2019
Last Recertification Date
Entity Termination Date
7/1/2019
Pharmacy Details
Pharmacy Name
AZ PHARMACY, LLC
Pharmacy Address
DBA AMAZON PHARMACY #002
3809 E WATKINS ST
PHOENIX, AZ 85034
Pharmacy Comments
Contract Details
Approval Date
1/14/2019
Contract Begin Date
4/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2019
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Eric Battis, COO
(623) 583-3001 Ext: 1222
Contract Pharmacy Representative
PILLPACK, INC.
GEOFF SWINDLE, CHIEF BUSINESS OFFICER
(855) 745-5725
Signed By Date
1/14/2019
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