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US BIOSERVICES
CAH031302-00 NORTHERN COCHISE COMMUNITY HOSPITAL, INC.
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Covered Entity Details
Entity Name
NORTHERN COCHISE COMMUNITY HOSPITAL, INC.
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH031302-00
Entity Address
901 WEST REX ALLEN DRIVE
WILLCOX, AZ 85643
Medicare Provider Number
031302
Participating Start Date
8/5/2010
Last Recertification Date
8/12/2024
Pharmacy Details
Pharmacy Name
US BIOSERVICES
Pharmacy Address
US BIOSERVICE CORPORATION
5025 PLANO PARKWAY
STE 100
CARROLLTON, TX 75010
Pharmacy Comments
Contract Details
Approval Date
10/14/2020
Contract Begin Date
1/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Connie Renae Dineen, CNO
(520) 766-6413
Contract Pharmacy Representative
US Bioservices Corporation
Mischelle Smoot, Pharmacist in Charge
(888) 518-7246
Signed By Date
10/14/2020
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