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CH09289N NORTH COUNTRY HEALTHCARE, INC. (Terminated)
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Main Details
Name
NORTH COUNTRY HEALTHCARE, INC.
Subdivision Name
NORTH COUNTRY - FLAGSTAFF CO-LOCATION SITE
Type
HRSA-Funded Health Center
Site ID
BPS-H80-008454
340B ID
CH09289N
Grant Number
H80CS00651
Additional Details
Current Program Status
Terminated
Registration Date
10/1/2013
Participating Start Date
1/1/2014
Participating Approval Date
11/6/2013
Last Recertification Date
2/4/2021
Termination Date
Termination Reason
4/1/2022
Business decision by the Covered Entity
Contacts
Authorizing Official
North Country HealthCare
ANNE NEWLAND, CEO
(928) 522-9564
Primary Contact
North Country HealthCare
KIMBERLY CHEN, DIRECTOR OF PHARMACY
(928) 522-9572
Addresses
Street Address
2187 NORTH VICKEY STREET STE 2
FLAGSTAFF, AZ 86004
Billing Address
NORTH COUNTRY HEALTHCARE
PO BOX 3630
FLAGSTAFF, AZ 86003
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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June 2025
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