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ARIZONA CVS STORES, L.L.C.
DSH030022 MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT
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Covered Entity Details
Entity Name
MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH030022
Entity Address
MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT DBA VALLEYWISE HEALTH
2601 EAST ROOSEVELT STREET
PHOENIX, AZ 85008
Medicare Provider Number
030022
Participating Start Date
10/4/2018
Last Recertification Date
8/24/2024
Pharmacy Details
Pharmacy Name
ARIZONA CVS STORES, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 09290
4430 EAST RAY ROAD
PHOENIX, AZ 85044
Pharmacy Comments
Contract Details
Approval Date
4/11/2021
Contract Begin Date
7/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Michael White, Executive Vice President, Chief Clinical Officer
(602) 344-5503
Contract Pharmacy Representative
CVS Pharmacies
Christian Reid, 340B Program Director
(401) 770-2118
Signed By Date
4/11/2021
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