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AZ PHARMACY, LLC
CH080730 METRO COMMUNITY PROVIDER NETWORK, INC.
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Covered Entity Details
Entity Name
METRO COMMUNITY PROVIDER NETWORK, INC.
Subdivision Name
STRIDE CHC- Peoria
Type
HRSA-Funded Health Center
340B ID
CH080730
Entity Address
3292 Peoria St
Aurora, CO 80010
Grant Number
H80CS00217
Participating Start Date
12/1/1992
Last Recertification Date
2/21/2025
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
1/9/2019
Contract Begin Date
4/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Ben Wiederholt, CEO
(303) 761-1977 Ext: 1103
Contract Pharmacy Representative
PillPack, Inc.
Geoff Swindle, Administrator
(855) 745-5725
Signed By Date
1/9/2019
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