Contract Pharmacy Details

CVS CAREMARK
CH09287T CHIRICAHUA COMMUNITY HEALTH CENTERS INC

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

CVS CAREMARK

Pharmacy Address

DBA CVS/CAREMARK OR CF# 11506
1 GREAT VALLEY BOULEVARD
WILKES BARRE, PA 18706

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

340B Drug Pricing Program Database