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YRMC FOOTHILLS PHARMACY
DSH030013 YUMA REGIONAL MEDICAL CENTER
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Covered Entity Details
Entity Name
YUMA REGIONAL MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH030013
Entity Address
2400 S Avenue A
Yuma, AZ 85364
Medicare Provider Number
030013
Participating Start Date
1/1/2005
Last Recertification Date
8/22/2024
Pharmacy Details
Pharmacy Name
YRMC FOOTHILLS PHARMACY
Pharmacy Address
PROXSYSRX-AZ, LLC
11351 E SOUTH FRONTAGE RD
YUMA, AZ 85367
Pharmacy Comments
Contract Details
Approval Date
7/10/2024
Contract Begin Date
10/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Vernon Moore, Chief Financial Officer
(928) 336-7015
Contract Pharmacy Representative
The Pharmacy at DeSoto
George Salem, Primary Contact
(662) 253-8206
Signed By Date
7/10/2024
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