Contract Pharmacy Details

AZ PHARMACY, LLC
CH099010 BORREGO COMMUNITY HEALTH FOUNDATION

Covered Entity Details

Entity Name

BORREGO COMMUNITY HEALTH FOUNDATION

Subdivision Name

BORREGO COMMUNITY HEALTH FOUNDATION

Type

HRSA-Funded Health Center

340B ID

CH099010

Entity Address

4343 YAQUI PASS ROAD
BORREGO SPRINGS, CA 92004-2369

Grant Number

H80CS00287

Participating Start Date

1/1/2003

Last Recertification Date

2/13/2023

Entity Termination Date

4/1/2024

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

1/15/2020

Contract Begin Date

4/1/2020

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

4/1/2024
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Mikia Wallis, Chief Executive Officer
(760) 767-6641

Contract Pharmacy Representative

PillPack, Inc.
Geoff Swindle, Administrator
(855) 745-5725

Signed By Date

1/15/2020

340B Drug Pricing Program Database