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SMITHS FOOD AND DRUG CENTER
CH09942A YAVAPAI, COUNTY OF
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Covered Entity Details
Entity Name
YAVAPAI, COUNTY OF
Subdivision Name
PRESCOTT VALLEY
Type
HRSA-Funded Health Center
340B ID
CH09942A
Entity Address
3212 N Windsong Dr
Prescott Valley, AZ 86314-2254
Grant Number
H80CS00842
Participating Start Date
4/1/2020
Last Recertification Date
2/19/2025
Pharmacy Details
Pharmacy Name
SMITHS FOOD AND DRUG CENTER
Pharmacy Address
DBA FRYS FOOD & DRUG #63
3100 N. GLASSFORD HILL ROAD
PRESCOTT VALLEY, AZ 86314
Pharmacy Comments
Contract Details
Approval Date
4/15/2020
Contract Begin Date
4/15/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Sharon Rickman, Director
(928) 442-5285
Contract Pharmacy Representative
Kroger
Anastasia Frey, Senior Manager, Payor Contracting
(513) 698-1875
Signed By Date
4/15/2020
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