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MEDIMPACT DIRECT, LLC
CH010850 COOS COUNTY FAMILY HEALTH SERVICES, INC.
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Covered Entity Details
Entity Name
COOS COUNTY FAMILY HEALTH SERVICES, INC.
Subdivision Name
COOS COUNTY FAMILY HEALTH SVCS
Type
HRSA-Funded Health Center
340B ID
CH010850
Entity Address
133 Pleasant St
Berlin, NH 03570-2006
Grant Number
H80CS00508
Participating Start Date
7/1/2004
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
MEDIMPACT DIRECT, LLC
Pharmacy Address
8060 S KYRENE RD
TEMPE, AZ 85284-2109
Pharmacy Comments
Contract Details
Approval Date
7/17/2018
Contract Begin Date
10/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2020
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
KEN GORDON, CEO
(603) 752-2040 Ext: 4018
Contract Pharmacy Representative
Medimpact Direct
Mike Simas, General Manager
(855) 873-8739
Signed By Date
7/17/2018
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