Contract Pharmacy Details

SMITHS FOOD & DRUG CENTERS
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

SMITHS FOOD & DRUG CENTERS

Pharmacy Address

DBA FRYS FOOD & DRUG #623
1815 W. GLENDALE AVENUE
PHOENIX, AZ 85021

Pharmacy Comments

Contract Details

Approval Date

10/13/2016

Contract Begin Date

1/1/2017

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Richard Miller, CFO
(623) 583-3001

Contract Pharmacy Representative

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

Signed By Date

10/13/2016

340B Drug Pricing Program Database