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DEWEY PHARMACY
FP86314 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 VALLEY CLINIC
Type
Family Planning (Title X only)
340B ID
FP86314
Entity Address
3212 N WINDSONG DRIVE
PRESCOTT VALLEY, AZ 86314
Grant Number
FPHPA006520
Participating Start Date
7/1/2024
Last Recertification Date
5/6/2025
Pharmacy Details
Pharmacy Name
DEWEY PHARMACY
Pharmacy Address
NORTHERN ARIZONA PHARMACY, LLC
12075 E STATE ROUTE 69 STE E
DEWEY, AZ 86327-4517
Pharmacy Comments
Contract Details
Approval Date
6/25/2021
Contract Begin Date
6/29/2021
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
6/25/2021
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