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NEVADA CVS PHARMACY, L.L.C.
DSH290007 UNIVERSITY MEDICAL CENTER OF SOUTHERN NEVADA
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Covered Entity Details
Entity Name
UNIVERSITY MEDICAL CENTER OF SOUTHERN NEVADA
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH290007
Entity Address
1800 W Charleston Blvd.
LAS VEGAS, NV 89102
Medicare Provider Number
290007
Participating Start Date
7/1/1994
Last Recertification Date
8/26/2024
Pharmacy Details
Pharmacy Name
NEVADA CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 09770
2830 BICENTENNIAL PKWY.
HENDERSON, NV 89044
Pharmacy Comments
Contract Details
Approval Date
4/15/2021
Contract Begin Date
7/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Mason Van Houweling, CEO
(702) 383-3862
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
4/15/2021
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