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AZ PHARMACY, LLC
CH09311BX ALTAMED HEALTH SERVICES CORPORATION
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Covered Entity Details
Entity Name
ALTAMED HEALTH SERVICES CORPORATION
Subdivision Name
AltaMed - Lime
Type
HRSA-Funded Health Center
340B ID
CH09311BX
Entity Address
513 E Lime Ave STE 101-102
Monrovia, CA 91016
Grant Number
H80CS00142
Participating Start Date
4/1/2024
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
AZ PHARMACY, LLC
Pharmacy Address
DBA AMAZON PHARMACY #002
3809 E WATKINS ST
PHOENIX, AZ 85034
Pharmacy Comments
Contract Details
Approval Date
7/3/2024
Contract Begin Date
10/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jose Esparza, Sr. VP, Finance & CFO
(323) 889-7320
Contract Pharmacy Representative
WellPartner
Kristen Danahy, Advisor/Manager, Account Management
(480) 364-2573
Signed By Date
7/3/2024
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