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CASA GRANDE PHARMACY
CH090090 MARIPOSA COMMUNITY HEALTH CENTER, INC.
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Covered Entity Details
Entity Name
MARIPOSA COMMUNITY HEALTH CENTER, INC.
Subdivision Name
MARIPOSA COMMUNITY HEALTH CENTER
Type
HRSA-Funded Health Center
340B ID
CH090090
Entity Address
1852 N Mastick Way
Nogales, AZ 85621-1063
Grant Number
H80CS00752
Participating Start Date
12/1/1992
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
CASA GRANDE PHARMACY
Pharmacy Address
1659 E FLORENCE BLVD, STE 7
CASA GRANDE, AZ 85122-4785
Pharmacy Comments
Contract Details
Approval Date
1/8/2019
Contract Begin Date
4/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/8/2019
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Ed Sicurello, CEO
(520) 761-2128
Contract Pharmacy Representative
SPECIALTY PHARMACY
PUJAN PATEL, OWNER
(520) 836-4646
Signed By Date
1/8/2019
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