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BEYOND PHARMACY WILLCOX
CH092870 CHIRICAHUA COMMUNITY HEALTH CENTERS INC
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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
BEYOND PHARMACY WILLCOX
Pharmacy Address
902 W REX ALLEN DR
WILLCOX, AZ 85643
Pharmacy Comments
Contract Details
Approval Date
10/14/2015
Contract Begin Date
1/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/5/2018
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Jonathan Melk, CEO
(520) 227-9167
Contract Pharmacy Representative
The Medicine Shoppe
Marla Trepanier, RPh
(520) 586-1299
Signed By Date
10/14/2015
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