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ARIZONA CVS STORES, L.L.C.
CH09289S NORTH COUNTRY HEALTHCARE, INC.
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Covered Entity Details
Entity Name
NORTH COUNTRY HEALTHCARE, INC.
Subdivision Name
North Country - Kingman Integration
Type
HRSA-Funded Health Center
340B ID
CH09289S
Entity Address
3505 WESTERN AVE Ste B
KINGMAN, AZ 86409-3071
Grant Number
H80CS00651
Participating Start Date
7/1/2017
Last Recertification Date
2/25/2025
Pharmacy Details
Pharmacy Name
ARIZONA CVS STORES, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 08977
3501 STOCKTON HILL RD.
KINGMAN, AZ 86409
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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