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DISTRICT OF COLUMBIA CVS PHARMACY, L.L.C
RWI20005 MetroHealth
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Covered Entity Details
Entity Name
MetroHealth
Subdivision Name
Type
Ryan White Part A
340B ID
RWI20005
Entity Address
1012 14th Street, NW
Suite 700
Washington, DC 20005
Grant Number
H89HA00012
Participating Start Date
10/1/2019
Last Recertification Date
2/23/2022
Entity Termination Date
4/1/2023
Pharmacy Details
Pharmacy Name
DISTRICT OF COLUMBIA CVS PHARMACY, L.L.C
Pharmacy Address
DBA: CVS/PHARMACY # 02834
3031 14TH ST., NW
WASHINGTON, DC 20009
Pharmacy Comments
Contract Details
Approval Date
10/11/2019
Contract Begin Date
1/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2023
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Miguel McInnis, CEO
(202) 838-9271
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
10/11/2019
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