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AZ PHARMACY, LLC
CH03377B GREATER BADEN MEDICAL SERVICE INC
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Covered Entity Details
Entity Name
GREATER BADEN MEDICAL SERVICE INC
Subdivision Name
Greater Baden Medical Services at Leonardtown
Type
HRSA-Funded Health Center
340B ID
CH03377B
Entity Address
23140 Moakley St STE 4
Leonardtown, MD 20650-2923
Grant Number
H80CS00549
Participating Start Date
4/1/2004
Last Recertification Date
2/10/2025
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
7/15/2019
Contract Begin Date
10/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Christopher A DeMarco, Chief Executive Officer
(301) 888-2233 Ext: 3306
Contract Pharmacy Representative
PillPack, Inc.
Geoff Swindle, Administrator
(855) 745-5725
Signed By Date
7/15/2019
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