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SMITH'S PHARMACY
CHC28370-02 Tri-State Community Healthcare Center
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Covered Entity Details
Entity Name
Tri-State Community Healthcare Center
Subdivision Name
Tri-State Community Healthcare Center- Mohave Valley
Type
HRSA-Funded Health Center
340B ID
CHC28370-02
Entity Address
8700 AZ-95
Mohave Valley, AZ 86440
Grant Number
H80CS28370
Participating Start Date
10/1/2019
Last Recertification Date
2/17/2025
Pharmacy Details
Pharmacy Name
SMITH'S PHARMACY
Pharmacy Address
4747 HWY 95
FT MOHAVE, AZ 86427
Pharmacy Comments
Contract Details
Approval Date
7/17/2019
Contract Begin Date
10/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Aram Manoukian, CEO
(760) 326-0222 Ext: 8186584000
Contract Pharmacy Representative
Kroger
Anastasia Frey, Senior Manager, Payor Contracting
(513) 698-1875
Signed By Date
7/15/2019
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