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CHINO VALLEY PHARMACY
FP86301 ARIZONA FAMILY HEALTH PARTNERSHIP
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Covered Entity Details
Entity Name
ARIZONA FAMILY HEALTH PARTNERSHIP
Subdivision Name
COMMUNITY HEALTH CENTER OF YAVAPAI - PRESCOTT CLINIC
Type
Family Planning (Title X only)
340B ID
FP86301
Entity Address
1090 COMMERCE DRIVE
PRESCOTT, AZ 86305
Grant Number
FPHPA006520
Participating Start Date
7/1/2024
Last Recertification Date
Entity Termination Date
4/1/2025
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
Contract Termination Date
Termination Reason
7/1/2022
Covered Entity Terminated
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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