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AZ PHARMACY, LLC
CH08126B Mountain Family Health Centers
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Covered Entity Details
Entity Name
Mountain Family Health Centers
Subdivision Name
Mountain Family Health Centers Glenwood Springs
Type
HRSA-Funded Health Center
340B ID
CH08126B
Entity Address
1905 BLAKE AVE
STE 101
GLENWOOD SPRINGS, CO 81601-4206
Grant Number
H80CS00830
Participating Start Date
10/1/1999
Last Recertification Date
2/11/2025
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
1/16/2019
Contract Begin Date
4/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2019
Agreement registered in error
Contacts
Covered Entity Signing Official
Art M Fernandez, Chief Operating Officer
(970) 945-2840 Ext: 7205
Contract Pharmacy Representative
AZ Pharmacy LLC
Geoff Swindle, Chief Business Officer
(801) 809-2584
Signed By Date
1/16/2019
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