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BEYOND PHARMACY BENSON DBA
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 BENSON DBA
Pharmacy Address
R&M PHARMACIES LLC
795 W 4TH ST
BENSON, AZ 85602
Pharmacy Comments
Contract Details
Approval Date
10/3/2016
Contract Begin Date
1/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
6/30/2021
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Roland Knox, CHIEF EXECUTIVE OFFICER
(520) 766-6465
Contract Pharmacy Representative
The Medicine Shoppe
Marla Trepanier, RPh
(520) 586-1299
Signed By Date
10/3/2016
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