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AZ PHARMACY, LLC
CHC08779-00 COMANCHE COUNTY HOSPITAL AUTHORITY (TRUST)
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Covered Entity Details
Entity Name
COMANCHE COUNTY HOSPITAL AUTHORITY (TRUST)
Subdivision Name
Comanche County Hospital Authority DBA Lawton Community Health Center
Type
HRSA-Funded Health Center
340B ID
CHC08779-00
Entity Address
5404 Southwest Lee Boulevard
Lawton, OK 73505
Grant Number
H80CS08779
Participating Start Date
7/1/2009
Last Recertification Date
2/12/2025
Pharmacy Details
Pharmacy Name
AZ PHARMACY, LLC
Pharmacy Address
DBA AMAZON PHARMACY #002
3809 E WATKINS ST
PHOENIX, AZ 85034
Pharmacy Comments
Contract Details
Approval Date
1/4/2019
Contract Begin Date
4/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Brent Smith, CEO
(580) 585-5852
Contract Pharmacy Representative
PillPack, Inc.
Geoff Swindle, Administrator
(855) 745-5725
Signed By Date
1/4/2019
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