Contract Pharmacy Details

GERMAN DOBSON CVS, L.L.C.
STD850121 Spectrum Medical Care Center

Covered Entity Details

Entity Name

Spectrum Medical Care Center

Subdivision Name

Type

Sexually Transmitted Diseases

340B ID

STD850121

Entity Address

200 E Monterey Way
Phoenix, AZ 85012

Grant Number

1 NU62PS924550-01-00

Participating Start Date

1/1/2020

Last Recertification Date

5/8/2023

Entity Termination Date

7/1/2023

Pharmacy Details

Pharmacy Name

GERMAN DOBSON CVS, L.L.C.

Pharmacy Address

CVS/PHARMACY # 2963
711 E. INDIAN SCHOOL RD.
PHOENIX, AZ 85014

Pharmacy Comments

Contract Details

Approval Date

11/8/2019

Contract Begin Date

1/1/2020

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

7/1/2020
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Thanes J Vanig, Chief Medical Officer
(602) 604-9500

Contract Pharmacy Representative

CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782

Signed By Date

10/15/2019

340B Drug Pricing Program Database