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FRY'S FOOD STORES #699
DSH030013 YUMA REGIONAL MEDICAL CENTER
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Covered Entity Details
Entity Name
YUMA REGIONAL MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH030013
Entity Address
2400 S Avenue A
Yuma, AZ 85364
Medicare Provider Number
030013
Participating Start Date
1/1/2005
Last Recertification Date
8/22/2024
Pharmacy Details
Pharmacy Name
FRY'S FOOD STORES #699
Pharmacy Address
11203 SOUTH FRONTAGE RD.
YUMA, AZ 85367
Pharmacy Comments
Contract Details
Approval Date
4/27/2015
Contract Begin Date
7/1/2015
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
David Willie, CFO
(928) 336-7015
Contract Pharmacy Representative
Kroger
Anastasia Frey, Senior Manager, Payor Contracting
(513) 698-1875
Signed By Date
4/27/2015
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