Common Contracts
1 similar Program Provider Agreement contracts
VACCINES FOR CHILDREN (VFC) PROGRAM PROVIDER AGREEMENTProgram Provider Agreement • March 9th, 2022
FACILITY INFORMATION Facility Name: MOHAVE CHD-BULLHEAD CITY VFC Pin#: 0009B Facility Address: 1222 HANCOCK RD City: BULLHEAD CITY County: MOHAVE State: AZ Zip: 86442 Telephone: (928)753-0714 Fax: (928)753-0775 MEDICAL DIRECTOR OR EQUIVALENT Last Name, First, MI: NGUYEN, DAT, Title:MD Specialty: Provide Information for second individual as needed: Last Name, First, MI: Title: Specialty: VFC VACCINE COORDINATOR Primary Vaccine Coordinator Name: LEWIS, CHERINE Back-Up Vaccine Coordinator Name: GRIFFITH, KATHRYN
