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CASA GRANDE PHARMACY
CH090030 SUN LIFE FAMILY HEALTH CENTER, INC.
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Covered Entity Details
Entity Name
SUN LIFE FAMILY HEALTH CENTER, INC.
Subdivision Name
Sun Life Health - Casa Grande Family Practice, Dental & Orthodontics
Type
HRSA-Funded Health Center
340B ID
CH090030
Entity Address
865 N Arizola Rd
Casa Grande, AZ 85122-6011
Grant Number
H80CS00466
Participating Start Date
12/1/1992
Last Recertification Date
2/21/2025
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
4/15/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
6/1/2021
Pharmacy closed
Contacts
Covered Entity Signing Official
TRAVIS ROBINETTE, CEO
(520) 836-3446 Ext: 2303
Contract Pharmacy Representative
SPECIALTY PHARMACY
PUJAN PATEL, OWNER
(520) 836-4646
Signed By Date
4/15/2019
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