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CORDES PHARMACY
STD86305 Northland Cares
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Covered Entity Details
Entity Name
Northland Cares
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD86305
Entity Address
Northland Cares
3188 N Windsong Drive
A
Prescott Valley, AZ 86314
Grant Number
NU62PS924818
Participating Start Date
10/1/2019
Last Recertification Date
5/9/2025
Pharmacy Details
Pharmacy Name
CORDES PHARMACY
Pharmacy Address
NORTHERN ARIZONA PHARMACY
20172 E STAGECOACH TRL STE A
CORDES LAKES, AZ 86333-2357
Pharmacy Comments
Contract Details
Approval Date
10/14/2024
Contract Begin Date
1/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Johnny Martinez, Executive Director
(928) 776-4612
Contract Pharmacy Representative
Chino Valley Pharmacy
Jason Dykstra, Owner
(928) 515-0046
Signed By Date
10/14/2024
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