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SMITH'S FOOD & DRUG CTRS
HV090750 MARICOPA COUNTY SPECIALTY HEALTH CARE DISTRICT
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Covered Entity Details
Entity Name
MARICOPA COUNTY SPECIALTY HEALTH CARE DISTRICT
Subdivision Name
Valleywise Community Health Center - McDowell
Type
Ryan White Part C
340B ID
HV090750
Entity Address
Valleywise Community Health Center - McDowell
1101 N. Central Ave.
Ste. 204
PHOENIX, AZ 85004
Grant Number
H76HA00151
Participating Start Date
7/1/1995
Last Recertification Date
2/20/2025
Pharmacy Details
Pharmacy Name
SMITH'S FOOD & DRUG CTRS
Pharmacy Address
DBA FRY'S FOOD STORES #89
11425 W BUCKEYE RD
AVONDALE, AZ 85323
Pharmacy Comments
Contract Details
Approval Date
4/17/2017
Contract Begin Date
7/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2017
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Kris Gaw, Chief Operating Officer
(602) 344-1258
Contract Pharmacy Representative
Kroger
Anastasia Frey, Senior Manager, Payor Contracting
(513) 698-1875
Signed By Date
4/17/2017
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