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CH09289B NORTH COUNTRY HEALTHCARE, INC. (Terminated)
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Main Details
Name
NORTH COUNTRY HEALTHCARE, INC.
Subdivision Name
NORTH COUNTRY - ASH FORK SITE
Type
HRSA-Funded Health Center
Site ID
BPS-H80-006769
340B ID
CH09289B
Grant Number
H80CS00651
Additional Details
Current Program Status
Terminated
Registration Date
7/1/2002
Participating Start Date
7/1/2002
Participating Approval Date
5/11/2010
Last Recertification Date
1/29/2020
Termination Date
Termination Reason
1/1/2021
Site closure
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
112 PARK AVENUE
ASH FORK, AZ 86320-0000
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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4/24/12 Updated Medicaid #. 5/11/10 ENTITY NAME CHANGE (WAS NORTH COUNTRY COMMUNITY HEALTH CTR)
04/24/2012
5/11/10 ENTITY NAME CHANGE (WAS NORTH COUNTRY COMMUNITY HEALTH CTR)
05/13/2010
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