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CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC
CH09287U CHIRICAHUA COMMUNITY HEALTH CENTERS INC
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Covered Entity Details
Entity Name
CHIRICAHUA COMMUNITY HEALTH CENTERS INC
Subdivision Name
Mobile Medical Clinic 'Sue'
Type
HRSA-Funded Health Center
340B ID
CH09287U
Entity Address
1100 N F Ave
Douglas, AZ 85607-1919
Grant Number
H80CS00696
Participating Start Date
4/1/2022
Last Recertification Date
3/3/2025
Pharmacy Details
Pharmacy Name
CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC
Pharmacy Address
DBA CVS/CAREMARK 48067
1780 WALL ST
MT PROSPECT, IL 60056
Pharmacy Comments
Contract Details
Approval Date
7/9/2024
Contract Begin Date
10/1/2024
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
7/9/2024
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