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ST JOHNS DRUG
CH092890 NORTH COUNTRY HEALTHCARE, INC.
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Covered Entity Details
Entity Name
NORTH COUNTRY HEALTHCARE, INC.
Subdivision Name
NORTH COUNTRY - FLAGSTAFF CLINIC
Type
HRSA-Funded Health Center
340B ID
CH092890
Entity Address
2920 N 4th St
Flagstaff, AZ 86004-1816
Grant Number
H80CS00651
Participating Start Date
7/1/1998
Last Recertification Date
2/18/2025
Pharmacy Details
Pharmacy Name
ST JOHNS DRUG
Pharmacy Address
1155 W. CLEVELAND
PO BOX 517
ST JOHNS, AZ 85936
Pharmacy Comments
Contract Details
Approval Date
10/31/2012
Contract Begin Date
10/31/2012
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
ANN ROGGENBUCK, CEO
(928) 213-6100 Ext: 2300
Contract Pharmacy Representative
Western Drug
Fred Harper, President
(928) 337-2229
Signed By Date
9/5/2012
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