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THE KROGER CO.
STD85004 Prisma Community Care
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Covered Entity Details
Entity Name
Prisma Community Care
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD85004
Entity Address
1101 N Central Ave
Suite 200
Phoenix, AZ 85004
Grant Number
5 NU62PS924676-03-00
Participating Start Date
1/1/2019
Last Recertification Date
5/8/2024
Pharmacy Details
Pharmacy Name
THE KROGER CO.
Pharmacy Address
FRY'S PHARMACY #128
744 W CAMELBACK ROAD
PHOENIX, AZ 85013
Pharmacy Comments
Contract Details
Approval Date
4/7/2022
Contract Begin Date
7/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jessyca Leach, Executive Director
(602) 595-8115
Contract Pharmacy Representative
WellPartner
Anthony McEeachern, Anthony McEachern
(315) 314-1802
Signed By Date
4/7/2022
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