340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
KING TUT PHARMACY
CAH031312-00 Bisbee Hospital Association dba Copper Queen Community Hospital
Print
Covered Entity Details
Entity Name
Bisbee Hospital Association dba Copper Queen Community Hospital
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH031312-00
Entity Address
101 Cole Ave
Bisbee, AZ 85603
Medicare Provider Number
031312
Participating Start Date
4/1/2013
Last Recertification Date
8/26/2024
Pharmacy Details
Pharmacy Name
KING TUT PHARMACY
Pharmacy Address
90 E 3RD ST
SUITE B
DOUGLAS, AZ 85607
Pharmacy Comments
Contract Details
Approval Date
10/9/2018
Contract Begin Date
1/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
8/26/2024
Pharmacy closed
Contacts
Covered Entity Signing Official
Heather A Lundstrom, Chief Financial Officer
(520) 432-6450
Contract Pharmacy Representative
King Tut Pharmacy
Kariem Ismail, owner/pic
(520) 220-1281
Signed By Date
10/9/2018
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session