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GRAND ST. PAUL CVS, L.L.C.
PED243300-00 GILLETTE CHILDREN'S SPECIALTY HEALTHCARE
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Covered Entity Details
Entity Name
GILLETTE CHILDREN'S SPECIALTY HEALTHCARE
Subdivision Name
Type
Children's Hospital
340B ID
PED243300-00
Entity Address
200 UNIVERSITY AVENUE EAST
ST. PAUL, MN 55101
Medicare Provider Number
243300
Participating Start Date
7/1/2019
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
GRAND ST. PAUL CVS, L.L.C.
Pharmacy Address
CVS PHARMACY # 17380
7000 YORK AVE S
EDINA, MN 55435
Pharmacy Comments
Contract Details
Approval Date
10/15/2021
Contract Begin Date
1/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Patrick Michael Nolan, Chief Financial Officer
(651) 312-3105
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
10/15/2021
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