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AZ PHARMACY, LLC
CH011280 DIMOCK COMM HEALTH CENTER
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Covered Entity Details
Entity Name
DIMOCK COMM HEALTH CENTER
Subdivision Name
DIMOCK COMM HEALTH CENTER
Type
HRSA-Funded Health Center
340B ID
CH011280
Entity Address
45 DIMOCK ST
ROXBURY, MA 02119
Grant Number
H80CS00151
Participating Start Date
7/1/2003
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
1/15/2019
Contract Begin Date
4/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Myechia minter-Jordan, CEO
(617) 442-8800 Ext: 1201
Contract Pharmacy Representative
PillPack, Inc.
Geoff Swindle, Administrator
(855) 745-5725
Signed By Date
1/15/2019
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