Contract Pharmacy Details

DISTRICT OF COLUMBIA CVS PHARMACY, L.L.C
RWI20012 Casa Ruby, Inc.

Covered Entity Details

Entity Name

Casa Ruby, Inc.

Subdivision Name

Type

Ryan White Part A

340B ID

RWI20012

Entity Address

7530 Georgia Avenue NW
Washington, DC 20012

Grant Number

H89HA00012

Participating Start Date

1/1/2021

Last Recertification Date

2/28/2021

Entity Termination Date

4/1/2022

Pharmacy Details

Pharmacy Name

DISTRICT OF COLUMBIA CVS PHARMACY, L.L.C

Pharmacy Address

DBA: CVS/PHARMACY # 01349
5227 GEORGIA AVENUE NW
WASHINGTON, DC 20011

Pharmacy Comments

Contract Details

Approval Date

10/20/2021

Contract Begin Date

1/1/2022

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

4/1/2022
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Ruby Corado, Executive Director
(202) 641-8028

Contract Pharmacy Representative

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

Signed By Date

10/20/2021

340B Drug Pricing Program Database