Contract Pharmacy Details

AZ PHARMACY, LLC
CH092870 CHIRICAHUA COMMUNITY HEALTH CENTERS INC

Covered Entity Details

Entity Name

CHIRICAHUA COMMUNITY HEALTH CENTERS INC

Subdivision Name

Chiricahua Community Health Centers, Inc. Cliff Whetten Clinic

Type

HRSA-Funded Health Center

340B ID

CH092870

Entity Address

10566 N Highway 191
Elfrida, AZ 85610-9021

Grant Number

H80CS00696

Participating Start Date

7/1/1998

Last Recertification Date

3/3/2025

Pharmacy Details

Pharmacy Name

AZ PHARMACY, LLC

Pharmacy Address

DBA AMAZON PHARMACY #002
3809 E WATKINS ST
PHOENIX, AZ 85034

Pharmacy Comments

Contract Details

Approval Date

10/15/2024

Contract Begin Date

1/1/2025

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Jonathan Melk, CEO
(520) 227-9167

Contract Pharmacy Representative

PillPack by Amazon Pharmacy
John Lavin, Vice President
(714) 380-0579

Signed By Date

10/15/2024

340B Drug Pricing Program Database