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FRED MEYER STORES
CH101289A MAT SU HEALTH SERVICES INC
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Covered Entity Details
Entity Name
MAT SU HEALTH SERVICES INC
Subdivision Name
Burchell High School
Type
HRSA-Funded Health Center
340B ID
CH101289A
Entity Address
1775 W PARKS HWY
WASILLA, AK 99654-6935
Grant Number
H80CS04435
Participating Start Date
4/1/2016
Last Recertification Date
2/5/2021
Entity Termination Date
4/1/2022
Pharmacy Details
Pharmacy Name
FRED MEYER STORES
Pharmacy Address
DBA: FRED MEYER
1501 EAST PARKS HIGHWAY
WASILLA, AK 99654
Pharmacy Comments
Contract Details
Approval Date
4/15/2020
Contract Begin Date
7/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2022
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Kevin Munson, Chief Executive Officer
(907) 376-2411
Contract Pharmacy Representative
Kroger
Anastasia Frey, Senior Manager, Payor Contracting
(513) 698-1875
Signed By Date
4/15/2020
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