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DOUGLAS PHARMACY, LLC
CAH031312-00 Bisbee Hospital Association dba Copper Queen Community Hospital
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Covered Entity Details
Entity Name
Bisbee Hospital Association dba Copper Queen Community Hospital
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH031312-00
Entity Address
101 Cole Ave
Bisbee, AZ 85603
Medicare Provider Number
031312
Participating Start Date
4/1/2013
Last Recertification Date
8/26/2024
Pharmacy Details
Pharmacy Name
DOUGLAS PHARMACY, LLC
Pharmacy Address
DBA DOUGLAS HEALTH MART PHARMACY
94 W 5TH STREET
DOUGLAS, AZ 85607
Pharmacy Comments
Contract Details
Approval Date
1/14/2014
Contract Begin Date
4/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
8/26/2024
Pharmacy closed
Contacts
Covered Entity Signing Official
James Ehasz, CFO
(520) 432-6450
Contract Pharmacy Representative
Greg Shumaker, Owner
(520) 364-2315
Signed By Date
1/14/2014
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