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SMITHS FOOD & DRUG CENTER INC
CAH031317-00 La Paz Regional Hospital
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Covered Entity Details
Entity Name
La Paz Regional Hospital
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH031317-00
Entity Address
1200 W Mohave Road
Parker, AZ 85344
Medicare Provider Number
031317
Participating Start Date
4/1/2014
Last Recertification Date
8/26/2024
Pharmacy Details
Pharmacy Name
SMITHS FOOD & DRUG CENTER INC
Pharmacy Address
SMITHS FOOD & DRUG #188
80 N. ACOMA BLVD.
LAKE HAVASU CITY, AZ 86403
Pharmacy Comments
Contract Details
Approval Date
4/2/2020
Contract Begin Date
7/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Kevin M Brown, CEO
(928) 669-7300
Contract Pharmacy Representative
Kroger
Anastasia Frey, Senior Manager, Payor Contracting
(513) 698-1875
Signed By Date
4/2/2020
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