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SMITH'S PHARMACY
CHC28370-12 TRI-STATE COMMUNITY HEALTHCARE CENTER
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Covered Entity Details
Entity Name
TRI-STATE COMMUNITY HEALTHCARE CENTER
Subdivision Name
Tri-State Community Healthcare Center- Needles
Type
HRSA-Funded Health Center
340B ID
CHC28370-12
Entity Address
820 W Broadway St
Needles, CA 92363-2729
Grant Number
H80CS28370
Participating Start Date
1/1/2024
Last Recertification Date
2/17/2025
Pharmacy Details
Pharmacy Name
SMITH'S PHARMACY
Pharmacy Address
4747 HWY 95
FT MOHAVE, AZ 86427
Pharmacy Comments
Contract Details
Approval Date
10/19/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
MARIA A SOTNIKOVA, COO
(818) 658-4000
Contract Pharmacy Representative
Kroger
Anastasia Frey, Senior Manager, Payor Contracting
(513) 698-1875
Signed By Date
10/12/2023
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