Contract Pharmacy Details

ALBERTSON'S LLC
CHC33644-00 MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT

Covered Entity Details

Entity Name

MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT

Subdivision Name

Valleywise Health Administrative Building

Type

HRSA-Funded Health Center

340B ID

CHC33644-00

Entity Address

2601 E Roosevelt St
Phoenix, AZ 85008

Grant Number

H80CS33644

Participating Start Date

1/1/2020

Last Recertification Date

2/19/2025

Pharmacy Details

Pharmacy Name

ALBERTSON'S LLC

Pharmacy Address

OSCO DRUG #980
1951 W BASELINE
MESA, AZ 85202

Pharmacy Comments

Contract Details

Approval Date

1/10/2020

Contract Begin Date

1/10/2020

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

9/4/2024
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Richard Mutarelli, Executive Vice President, Chief Financial Officer
(602) 344-8425

Contract Pharmacy Representative

Albersons
Chuck Hanson, 340B Program Manager
(208) 395-6304

Signed By Date

1/10/2020

340B Drug Pricing Program Database