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BEEWELL PHARMACY BISBEE
CAH031312-00 Bisbee Hospital Association dba Copper Queen Community Hospital
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Covered Entity Details
Entity Name
Bisbee Hospital Association dba Copper Queen Community Hospital
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH031312-00
Entity Address
101 Cole Ave
Bisbee, AZ 85603
Medicare Provider Number
031312
Participating Start Date
4/1/2013
Last Recertification Date
8/26/2024
Pharmacy Details
Pharmacy Name
BEEWELL PHARMACY BISBEE
Pharmacy Address
101 COLE AVE BLDG B
BISBEE, AZ 85603
Pharmacy Comments
Contract Details
Approval Date
10/8/2024
Contract Begin Date
1/1/2025
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
3/31/2025
Pharmacy closed
Contacts
Covered Entity Signing Official
Heather A Lundstrom, Chief Financial Officer
(520) 432-6450
Contract Pharmacy Representative
Beewell Pharmacy Bisbee
Janet Buchner, Owner
(520) 895-3233
Signed By Date
10/8/2024
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