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SMITHS FOOD AND DRUG CENTERS INC
RRC030119-00 MERCY GILBERT MEDICAL CENTER
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Covered Entity Details
Entity Name
MERCY GILBERT MEDICAL CENTER
Subdivision Name
Type
Rural Referral Center
340B ID
RRC030119-00
Entity Address
3555 S. VAL VISTA DRIVE
GILBERT, AZ 85297
Medicare Provider Number
030119
Participating Start Date
4/1/2018
Last Recertification Date
8/24/2023
Entity Termination Date
4/1/2024
Pharmacy Details
Pharmacy Name
SMITHS FOOD AND DRUG CENTERS INC
Pharmacy Address
DBA FRYS FOOD STORES OF AZ #669
2858 N PINAL AVE
CASA GRANDE, AZ 85122
Pharmacy Comments
Contract Details
Approval Date
10/4/2019
Contract Begin Date
1/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/5/2020
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Eric Sorensen, CFO
(480) 728-3144 Ext: 4807283144
Contract Pharmacy Representative
Kroger
Anastasia Frey, Senior Manager, Payor Contracting
(513) 698-1875
Signed By Date
10/4/2019
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