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CORDES PHARMACY
STD86326 Northland Cares
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Covered Entity Details
Entity Name
Northland Cares
Subdivision Name
Cottonwood
Type
Sexually Transmitted Diseases
340B ID
STD86326
Entity Address
203 S. Candy Lane, Suite 3AB
Cottonwood, AZ 86326
Grant Number
NU62PS924818
Participating Start Date
4/1/2021
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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