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CORDES PHARMACY
CH099420 Yavapai County Community Health Services
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Covered Entity Details
Entity Name
Yavapai County Community Health Services
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
CORDES PHARMACY
Pharmacy Address
NORTHERN ARIZONA PHARMACY
20172 E STAGECOACH TRL STE A
CORDES LAKES, AZ 86333-2357
Pharmacy Comments
Contract Details
Approval Date
6/25/2021
Contract Begin Date
6/28/2021
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
6/25/2021
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