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AZ PHARMACY, LLC
CH093110 ALTAMED Health Services Corporation
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Covered Entity Details
Entity Name
ALTAMED Health Services Corporation
Subdivision Name
AltaMed Health Services Corporation Headquarters
Type
HRSA-Funded Health Center
340B ID
CH093110
Entity Address
2040 CAMFIELD AVENUE
Commerce, CA 90040
Grant Number
H80CS00142
Participating Start Date
4/1/2001
Last Recertification Date
2/11/2025
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
4/18/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jose Esparza, Sr. VP, Finance & CFO
(323) 889-7320
Contract Pharmacy Representative
PillPack, Inc.
Geoff Swindle, Administrator
(855) 745-5725
Signed By Date
4/18/2019
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