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BEYOND PHARMACY WILLCOX
CAH031302-00 NORTHERN COCHISE COMMUNITY HOSPITAL, INC.
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Covered Entity Details
Entity Name
NORTHERN COCHISE COMMUNITY HOSPITAL, INC.
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH031302-00
Entity Address
901 WEST REX ALLEN DRIVE
WILLCOX, AZ 85643
Medicare Provider Number
031302
Participating Start Date
8/5/2010
Last Recertification Date
8/12/2024
Pharmacy Details
Pharmacy Name
BEYOND PHARMACY WILLCOX
Pharmacy Address
902 W REX ALLEN DR
WILLCOX, AZ 85643
Pharmacy Comments
Contract Details
Approval Date
1/10/2014
Contract Begin Date
4/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
6/25/2024
Pharmacy closed
Contacts
Covered Entity Signing Official
Roland Knox, CHIEF EXECUTIVE OFFICER
(520) 766-6465
Contract Pharmacy Representative
Medicine Shoppe
Marla Trepanier, Pharmacy manager
(856) 324-5441
Signed By Date
1/10/2014
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