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GRAND ST. PAUL CVS, L.L.C.
CH053020 WEST SIDE COMMUNITY HEALTH SERVICES, INC.
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Covered Entity Details
Entity Name
WEST SIDE COMMUNITY HEALTH SERVICES, INC.
Subdivision Name
WESTSIDE COMMUNITY HEALTH SERVICES, INC.
Type
HRSA-Funded Health Center
340B ID
CH053020
Entity Address
153 Cesar Chavez St
Saint Paul, MN 55107-2226
Grant Number
H80CS00790
Participating Start Date
1/1/1997
Last Recertification Date
2/14/2025
Pharmacy Details
Pharmacy Name
GRAND ST. PAUL CVS, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 05998
499 SNELLING AVE. N.
ST PAUL, MN 55104
Pharmacy Comments
Contract Details
Approval Date
10/15/2019
Contract Begin Date
1/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2022
Pharmacy closed
Contacts
Covered Entity Signing Official
Reuben Moore, President & Executive Officer
(651) 602-7536
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
10/15/2019
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