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ST JOHNS DRUG
TB859361 APACHE COUNTY PUBLIC HEALTH SERVICES
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Covered Entity Details
Entity Name
APACHE COUNTY PUBLIC HEALTH SERVICES
Subdivision Name
Type
Tuberculosis
340B ID
TB859361
Entity Address
323 SOUTH MOUNTAIN AVENUE, SUITE 102
SPRINGERVILLE, AZ 85938
Grant Number
NU52PS004658
Participating Start Date
1/1/1999
Last Recertification Date
5/12/2025
Pharmacy Details
Pharmacy Name
ST JOHNS DRUG
Pharmacy Address
1155 W. CLEVELAND
PO BOX 517
ST JOHNS, AZ 85936
Pharmacy Comments
Contract Details
Approval Date
10/14/2018
Contract Begin Date
1/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Kristen Herrick, Chief, Office of Disease Integration and Services
(602) 653-5528
Contract Pharmacy Representative
St Johns Drug
Natasha Bradburn, St Johns Drug
(928) 337-2229
Signed By Date
10/14/2018
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