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GERMAN DOBSON CVS, L.L.C.
DSH030065 BANNER DESERT MEDICAL CENTER
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Covered Entity Details
Entity Name
BANNER DESERT MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH030065
Entity Address
1400 SOUTH DOBSON ROAD
MESA, AZ 85202
Medicare Provider Number
030065
Participating Start Date
1/1/2007
Last Recertification Date
8/12/2024
Pharmacy Details
Pharmacy Name
GERMAN DOBSON CVS, L.L.C.
Pharmacy Address
CVS PHARMACY # 17256
1800 E RIO SALADO PKWY STE 120
TEMPE, AZ 85281
Pharmacy Comments
Contract Details
Approval Date
1/23/2020
Contract Begin Date
4/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
6/24/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Cheryl A Tong, CFO
(602) 865-5751
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
1/23/2020
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