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VIRGINIA CVS PHARMACY, L.L.C.
STD23517 LGBT Life Center
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Covered Entity Details
Entity Name
LGBT Life Center
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD23517
Entity Address
248 W. 24th St
Norfolk, VA 23517
Grant Number
NU62PS924552
Participating Start Date
1/1/2017
Last Recertification Date
6/4/2023
Entity Termination Date
7/1/2024
Pharmacy Details
Pharmacy Name
VIRGINIA CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 05796
2315 W. MERCURY BLVD.
HAMPTON, VA 23666
Pharmacy Comments
Contract Details
Approval Date
7/24/2020
Contract Begin Date
10/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/16/2023
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Stacie Walls-Beegle, CEO
(757) 640-0929 Ext: 215
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
7/24/2020
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