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WAL-MART PHARMACY 10-2112
FQHCLA225A Maricopa County Special Health Care District
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Covered Entity Details
Entity Name
Maricopa County Special Health Care District
Subdivision Name
CHANDLER FAMILY HEALTH CENTER
Type
Health Center Program Look-Alike
340B ID
FQHCLA225A
Entity Address
811 S. HAMILTON
CHANDLER, AZ 85225
Grant Number
LALCS00037
Participating Start Date
10/1/2007
Last Recertification Date
2/14/2019
Entity Termination Date
4/1/2020
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-2112
Pharmacy Address
4915 NORTH PIMA ROAD
SCOTTSDALE, AZ 85251
Pharmacy Comments
Contract Details
Approval Date
4/29/2017
Contract Begin Date
7/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2020
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Kris Gaw, Chief Operating Officer
(602) 344-1258
Contract Pharmacy Representative
Healdsburg District Hospital
Kathi Phelps, Manager Contracting
(479) 277-3719
Signed By Date
4/29/2017
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