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CORDES PHARMACY
FP86326 ARIZONA FAMILY HEALTH PARTNERSHIP
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Covered Entity Details
Entity Name
ARIZONA FAMILY HEALTH PARTNERSHIP
Subdivision Name
COMMUNITY HEALTH CENTER OF YAVAPAI- COTTONWOOD
Type
Family Planning (Title X only)
340B ID
FP86326
Entity Address
51 Brian Mickelsen Parkway
COTTONWOOD, AZ 86326
Grant Number
FPHPA006520
Participating Start Date
7/1/2024
Last Recertification Date
5/6/2025
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
6/29/2021
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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