Contract Pharmacy Details

ARIZONA CVS STORES, L.L.C.
CH090250 CLINICAS DE SALUD DEL PUEBLO,Inc.

Covered Entity Details

Entity Name

CLINICAS DE SALUD DEL PUEBLO,Inc.

Subdivision Name

Innercare K Street

Type

HRSA-Funded Health Center

340B ID

CH090250

Entity Address

1166 K St
Brawley, CA 92227-2737

Grant Number

H80CS00733

Participating Start Date

12/1/1992

Last Recertification Date

2/12/2025

Pharmacy Details

Pharmacy Name

ARIZONA CVS STORES, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 09334
2800 S 4TH AVE
YUMA, AZ 85364

Pharmacy Comments

Contract Details

Approval Date

7/31/2020

Contract Begin Date

8/4/2020

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

YVONNE BELL, CEO
(760) 344-9951 Ext: 10102

Contract Pharmacy Representative

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

Signed By Date

7/31/2020

340B Drug Pricing Program Database