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GERMAN DOBSON CVS, L.L.C.
CH09289E NORTH COUNTRY HEALTHCARE, INC.
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Covered Entity Details
Entity Name
NORTH COUNTRY HEALTHCARE, INC.
Subdivision Name
NORTH COUNTRY - SHOW LOW CLINIC
Type
HRSA-Funded Health Center
340B ID
CH09289E
Entity Address
2650 E Show Low Lake Rd
Show Low, AZ 85901-7955
Grant Number
H80CS00651
Participating Start Date
7/1/2010
Last Recertification Date
2/23/2025
Pharmacy Details
Pharmacy Name
GERMAN DOBSON CVS, L.L.C.
Pharmacy Address
DBA CVS/PHARMACY # 2412
60 E DEUCE OF CLUBS DR.
SHOW LOW, AZ 85901
Pharmacy Comments
Contract Details
Approval Date
4/15/2024
Contract Begin Date
7/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
ANNE NEWLAND, CEO
(928) 522-9564
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
4/15/2024
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