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ACCREDO HEALTH GROUP INC
CH090090 MARIPOSA COMMUNITY HEALTH CENTER, INC.
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Covered Entity Details
Entity Name
MARIPOSA COMMUNITY HEALTH CENTER, INC.
Subdivision Name
MARIPOSA COMMUNITY HEALTH CENTER
Type
HRSA-Funded Health Center
340B ID
CH090090
Entity Address
1852 N Mastick Way
Nogales, AZ 85621-1063
Grant Number
H80CS00752
Participating Start Date
12/1/1992
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
ACCREDO HEALTH GROUP INC
Pharmacy Address
2410 WARDLOW RD
STE 101
CORONA, CA 92878
Pharmacy Comments
Contract Details
Approval Date
10/11/2024
Contract Begin Date
1/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Daniel Prevost, CEO
(520) 281-1550 Ext: 1005
Contract Pharmacy Representative
Accredo
Diana Florio, 340B Managing Director
(407) 988-7044
Signed By Date
10/11/2024
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