Contract Pharmacy Details

FRED MEYER STORES
CH107930 KODIAK ISLAND HEALTH CARE FOUNDATION

Covered Entity Details

Entity Name

KODIAK ISLAND HEALTH CARE FOUNDATION

Subdivision Name

KODIAK COMMUNITY HEALTH CENTER

Type

HRSA-Funded Health Center

340B ID

CH107930

Entity Address

1911 E Rezanof Dr
Kodiak, AK 99615-6602

Grant Number

H80CS01445

Participating Start Date

4/1/2004

Last Recertification Date

2/20/2025

Pharmacy Details

Pharmacy Name

FRED MEYER STORES

Pharmacy Address

DBA: FRED MEYER
1000 E NORTHERN LIGHTS BLVD
ANCHORAGE, AK 99508

Pharmacy Comments

Contract Details

Approval Date

4/15/2024

Contract Begin Date

7/1/2024

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

3/15/2025
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Carol Austerman, Executive Director/CEO
(907) 481-5002

Contract Pharmacy Representative

Kroger Health
Eva Brumfield, Strategic Program Director
(651) 357-2109

Signed By Date

4/15/2024

340B Drug Pricing Program Database