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UTAH CVS PHARMACY, L.L.C.
CAH051315-00 TRINITY HOSPITAL
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Covered Entity Details
Entity Name
TRINITY HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH051315-00
Entity Address
60 EASTER AVENUE
WEAVERVILLE, CA 96093
Medicare Provider Number
051315
Participating Start Date
10/1/2014
Last Recertification Date
8/22/2023
Entity Termination Date
1/1/2024
Pharmacy Details
Pharmacy Name
UTAH CVS PHARMACY, L.L.C.
Pharmacy Address
CVS PHARMACY # 16879
10130 S STATE ST
SANDY, UT 84070
Pharmacy Comments
Contract Details
Approval Date
7/14/2021
Contract Begin Date
10/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
9/30/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Jennifer Van Matre, Chief Financial Officer
(530) 623-5541 Ext: 3232
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
7/14/2021
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