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SMITHS FOOD & DRUG CENTER
CH093070 MOUNTAIN PARK HEALTH CENTER
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Covered Entity Details
Entity Name
MOUNTAIN PARK HEALTH CENTER
Subdivision Name
Mountain Park Health Center - Baseline
Type
HRSA-Funded Health Center
340B ID
CH093070
Entity Address
635 E Baseline Rd
Phoenix, AZ 85042-6551
Grant Number
H80CS00141
Participating Start Date
10/1/1996
Last Recertification Date
2/13/2025
Pharmacy Details
Pharmacy Name
SMITHS FOOD & DRUG CENTER
Pharmacy Address
DBA FRYS FOOD & DRUG #87
5140 W BASELINE RD
LAVEEN, AZ 85339
Pharmacy Comments
Contract Details
Approval Date
7/11/2019
Contract Begin Date
10/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
John R. Swagert, CEO
(602) 323-3470
Contract Pharmacy Representative
Kroger Health
Eva Brumfield, Strategic Program Director
(651) 357-2109
Signed By Date
7/11/2019
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