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RWII86305A Northland Cares (Terminated)
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Main Details
Name
Northland Cares
Subdivision Name
Type
Ryan White Part B
340B ID
RWII86305A
Grant Number
X07HA00080
Additional Details
Current Program Status
Terminated
Registration Date
1/12/2016
Participating Start Date
4/1/2016
Participating Approval Date
2/10/2016
Last Recertification Date
2/8/2020
Time Period the Assistance was Received
Termination Date
Termination Reason
7/1/2020
Site closure
Contacts
Authorizing Official
Northland Cares
Lisa Lahaie, Board President
(928) 776-4612
Primary Contact
Northland Cares
Donald L Sadler, Coordinator
(928) 776-4612 Ext: 108
Addresses
Street Address
107 West Frontier Road, Suite A
Payson, AZ 85541
Billing Address
Northland Cares
3112 Clearwater Dr., Suite A
Prescott, AZ 86305
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
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