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ARIZONA CVS STORES, L.L.C.
CH09287T CHIRICAHUA COMMUNITY HEALTH CENTERS INC
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Covered Entity Details
Entity Name
CHIRICAHUA COMMUNITY HEALTH CENTERS INC
Subdivision Name
Chiricahua Community Health Centers, Inc. Dardo Mobile Clinic
Type
HRSA-Funded Health Center
340B ID
CH09287T
Entity Address
815 E 15th St
Douglas, AZ 85607-1631
Grant Number
H80CS00696
Participating Start Date
4/1/2022
Last Recertification Date
3/3/2025
Pharmacy Details
Pharmacy Name
ARIZONA CVS STORES, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 08828
2090 EAST FRY BLVD.
SIERRA VISTA, AZ 85635
Pharmacy Comments
Contract Details
Approval Date
10/16/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jonathan Melk, CEO
(520) 227-9167
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
10/16/2023
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