340B Drug Pricing Program Database

Pharmacy Name

WISCONSIN CVS PHARMACY, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 05600
2149 PRAIRIE AVE.
BELOIT, WI 53511

Pharmacy Comments

Approval Date

10/14/2019

Contract Begin Date

1/1/2020

Carve-In Effective Date

Contract Comments

Covered Entity Signing Official

Shannon Dunphy-Alexander, Senior Vice President / CFO
(608) 757-3126

Contract Pharmacy Representative

CVS
Gabrielle Lagana, Implementation Consultant
(212) 419-4049

Signed By Date

10/14/2019