Contract Pharmacy Details

FRY'S FOOD & DRUG #674
CH093030 ADELANTE HEALTHCARE, INC.

Covered Entity Details

Entity Name

ADELANTE HEALTHCARE, INC.

Subdivision Name

Adelante Healthcare

Type

HRSA-Funded Health Center

340B ID

CH093030

Entity Address

3033 N. Central Ave.
Phoenix, AZ 85012-4403

Grant Number

H80CS00140

Participating Start Date

12/1/1992

Last Recertification Date

2/12/2025

Pharmacy Details

Pharmacy Name

FRY'S FOOD & DRUG #674

Pharmacy Address

13982 W. WADDELL ROAD
SURPRISE, AZ 85379

Pharmacy Comments

Contract Details

Approval Date

1/23/2015

Contract Begin Date

4/1/2015

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

1/12/2018
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

AVEIN SAATY TAFOYA, CEO
(623) 583-3001 Ext: 1207

Contract Pharmacy Representative

Kroger
Mike Puccini, New Business Development Manager
(513) 762-4672

Signed By Date

1/23/2015

340B Drug Pricing Program Database