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BASHAS' #54
CHC33644-00 MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT
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Covered Entity Details
Entity Name
MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT
Subdivision Name
Valleywise Health Administrative Building
Type
HRSA-Funded Health Center
340B ID
CHC33644-00
Entity Address
2601 E Roosevelt St
Phoenix, AZ 85008
Grant Number
H80CS33644
Participating Start Date
1/1/2020
Last Recertification Date
2/19/2025
Pharmacy Details
Pharmacy Name
BASHAS' #54
Pharmacy Address
RALEY'S ARIZONA LLC
142 E. HIGHWAY 260
PAYSON, AZ 85541
Pharmacy Comments
Contract Details
Approval Date
7/15/2024
Contract Begin Date
10/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Michael White, Executive Vice President, Chief Clinical Officer
(602) 344-5503
Contract Pharmacy Representative
Bashas Pharmacy
Rajdeep Bhanver, Director of Pharmacy
(916) 291-7741
Signed By Date
7/15/2024
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