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SMITHS FOOD & DRUG CENTER INC
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
SMITHS FOOD & DRUG CENTER INC
Pharmacy Address
SMITHS FOOD & DRUG #188
80 N. ACOMA BLVD.
LAKE HAVASU CITY, AZ 86403
Pharmacy Comments
Contract Details
Approval Date
7/10/2017
Contract Begin Date
10/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
ANNE NEWLAND, CEO
(928) 522-9564
Contract Pharmacy Representative
Kroger
Anastasia Frey, Senior Manager, Payor Contracting
(513) 698-1875
Signed By Date
7/10/2017
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