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EL RIO PASCUA PHARMACY
FQHC638290B PASCUA YAQUI HEALTH SERVICES DIVISION
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Covered Entity Details
Entity Name
PASCUA YAQUI HEALTH SERVICES DIVISION
Subdivision Name
CSBH ST MARYS
Type
Tribal Contract/Compact with IHS (P.L. 93-638)
340B ID
FQHC638290B
Entity Address
1775 W SAINT MARYS RD
TUCSON, AZ 85745-2696
Grant Number
Participating Start Date
10/1/2020
Last Recertification Date
3/4/2025
Pharmacy Details
Pharmacy Name
EL RIO PASCUA PHARMACY
Pharmacy Address
4567 W TETAKUSIM RD
TUCSON, AZ 85746
Pharmacy Comments
Contract Details
Approval Date
9/9/2020
Contract Begin Date
10/1/2020
Carve-In Effective Date
10/1/2020
Contract Comments
Contract Termination Date
Termination Reason
10/1/2023
Pharmacy closed
Contacts
Covered Entity Signing Official
Reuben T. Howard, Executive Director
(520) 879-6000 Ext: 6019
Contract Pharmacy Representative
Pascua Yaqui Health Services Division
Rosa M. Rivera, Administrator
(520) 879-6163
Signed By Date
9/9/2020
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