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NEVADA CVS PHARMACY, L.L.C.
CAH291309-00 BOULDER CITY HOSPITAL
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Covered Entity Details
Entity Name
BOULDER CITY HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH291309-00
Entity Address
901 ADAMS BLVD
BOULDER CITY, NV 89005-2247
Medicare Provider Number
291309
Participating Start Date
10/1/2015
Last Recertification Date
8/22/2024
Pharmacy Details
Pharmacy Name
NEVADA CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 08799
1360 E. FLAMINGO RD.
LAS VEGAS, NV 89119
Pharmacy Comments
Contract Details
Approval Date
7/12/2019
Contract Begin Date
10/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2020
Pharmacy closed
Contacts
Covered Entity Signing Official
Douglas B. Lewis, CFO
(702) 293-4111 Ext: 6509
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
7/12/2019
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