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SMITHS FOOD AND DRUG CENTERS
CH09307D MOUNTAIN PARK HEALTH CENTER
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Covered Entity Details
Entity Name
MOUNTAIN PARK HEALTH CENTER
Subdivision Name
Mountain Park Health Center - Gateway
Type
HRSA-Funded Health Center
340B ID
CH09307D
Entity Address
3830 E VAN BUREN ST
PHOENIX, AZ 85008-6920
Grant Number
H80CS00141
Participating Start Date
4/1/2006
Last Recertification Date
2/13/2025
Pharmacy Details
Pharmacy Name
SMITHS FOOD AND DRUG CENTERS
Pharmacy Address
DBA FRYS FOOD & DRUG #81
2250 E BASELINE RD
PHOENIX, AZ 85040
Pharmacy Comments
Contract Details
Approval Date
4/12/2024
Contract Begin Date
7/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
John R. Swagert, CEO
(602) 323-3470
Contract Pharmacy Representative
Kroger Health
Eva Brumfield, Strategic Program Director
(651) 357-2109
Signed By Date
4/12/2024
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