Contract Pharmacy Details

GERMAN DOBSON CVS, L.L.C.
DSH030002 Banner – University Medical Center Phoenix

Covered Entity Details

Entity Name

Banner – University Medical Center Phoenix

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH030002

Entity Address

1111 EAST MCDOWELL ROAD
PHOENIX, AZ 85006

Medicare Provider Number

030002

Participating Start Date

9/9/2005

Last Recertification Date

8/12/2024

Pharmacy Details

Pharmacy Name

GERMAN DOBSON CVS, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 07845
7552 E. INDIAN SCHOOL RD.
SCOTTSDALE, AZ 85251

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

Patricia Rhoden, Chief Financial Officer
(602) 839-8507

Contract Pharmacy Representative

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

Signed By Date

7/15/2020

340B Drug Pricing Program Database