Contract Pharmacy Details

ARIZONA CVS STORES, L.L.C.
DSH030089 BANNER THUNDERBIRD MEDICAL CENTER

Covered Entity Details

Entity Name

BANNER THUNDERBIRD MEDICAL CENTER

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH030089

Entity Address

5555 W. Thunderbird Road
Glendale, AZ 85306

Medicare Provider Number

030089

Participating Start Date

1/1/2007

Last Recertification Date

8/30/2024

Pharmacy Details

Pharmacy Name

ARIZONA CVS STORES, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 09237
9856 W. PEORIA AVE.
PEORIA, AZ 85345

Pharmacy Comments

Contract Details

Approval Date

1/20/2020

Contract Begin Date

4/1/2020

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Jeremy Williams, Chief Financial Officer
(623) 524-4083

Contract Pharmacy Representative

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

Signed By Date

1/20/2020

340B Drug Pricing Program Database