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CHINO VALLEY PHARMACY
CH099420 YAVAPAI, COUNTY OF
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Covered Entity Details
Entity Name
YAVAPAI, COUNTY OF
Subdivision Name
PRESCOTT
Type
HRSA-Funded Health Center
340B ID
CH099420
Entity Address
1090 Commerce Dr
Prescott, AZ 86305-3700
Grant Number
H80CS00842
Participating Start Date
4/1/2003
Last Recertification Date
2/13/2025
Pharmacy Details
Pharmacy Name
CHINO VALLEY PHARMACY
Pharmacy Address
1932 N STATE ROUTE 89
CHINO VALLEY, AZ 86323
Pharmacy Comments
Contract Details
Approval Date
4/14/2020
Contract Begin Date
4/15/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Sharon Rickman, Director
(928) 442-5285
Contract Pharmacy Representative
Chino Valley Pharmacy
Jason Dykstra, Manager
(928) 515-0046
Signed By Date
4/14/2020
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