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FRED MEYER STORES
CH1012890 MAT SU HEALTH SERVICES INC
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Covered Entity Details
Entity Name
MAT SU HEALTH SERVICES INC
Subdivision Name
Mat-Su Health Services, Inc.
Type
HRSA-Funded Health Center
340B ID
CH1012890
Entity Address
1363 W Spruce Ave
Wasilla, AK 99654-5327
Grant Number
H80CS04435
Participating Start Date
9/9/2005
Last Recertification Date
2/13/2025
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
4/17/2020
Contract Begin Date
7/1/2020
Carve-In Effective Date
Contract Comments
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
4/17/2020
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