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FRY'S PHARMACY #686
CH093030 ADELANTE HEALTHCARE, INC.
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Covered Entity Details
Entity Name
ADELANTE HEALTHCARE, INC.
Subdivision Name
Adelante Healthcare
Type
HRSA-Funded Health Center
340B ID
CH093030
Entity Address
3033 N. Central Ave.
Phoenix, AZ 85012-4403
Grant Number
H80CS00140
Participating Start Date
12/1/1992
Last Recertification Date
2/12/2025
Pharmacy Details
Pharmacy Name
FRY'S PHARMACY #686
Pharmacy Address
2724 S SIGNAL BUTTE RD
MESA, AZ 85209
Pharmacy Comments
Contract Details
Approval Date
1/24/2022
Contract Begin Date
4/1/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
2/8/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Pedro Cons, CEO
(623) 583-3001 Ext: 011105
Contract Pharmacy Representative
Kroger
Anastasia Frey, Senior Manager, Payor Contracting
(513) 698-1875
Signed By Date
1/24/2022
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