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VIRGINIA CVS PHARMACY, L.L.C.
DSH490032 Virginia Commonwealth University Health System
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Covered Entity Details
Entity Name
Virginia Commonwealth University Health System
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH490032
Entity Address
1250 East Marshall Street
RICHMOND, VA 23298
Medicare Provider Number
490032
Participating Start Date
12/1/1992
Last Recertification Date
9/6/2024
Pharmacy Details
Pharmacy Name
VIRGINIA CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 01988
3514 WEST CARY STREET
RICHMOND, VA 23221
Pharmacy Comments
Contract Details
Approval Date
7/15/2020
Contract Begin Date
10/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Paul Wesolowski, Chief Operating Officer
(804) 828-4607
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
7/15/2020
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