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CVS PHARMACY, INC.
STD78520 Valley AIDS Council
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Covered Entity Details
Entity Name
Valley AIDS Council
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD78520
Entity Address
857 E Washington
Brownsville, TX 78520
Grant Number
NU62PS924529
Participating Start Date
1/1/2020
Last Recertification Date
5/13/2025
Pharmacy Details
Pharmacy Name
CVS PHARMACY, INC.
Pharmacy Address
DBA CVS/PHARMACY # 4827
100 E FM 495
SAN JUAN, TX 78589
Pharmacy Comments
Contract Details
Approval Date
1/5/2022
Contract Begin Date
4/1/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
11/30/2023
Pharmacy closed
Contacts
Covered Entity Signing Official
Wally Cantu, Executive Director
(956) 428-2653
Contract Pharmacy Representative
CVS
Courtney Wilson, Representative
(817) 201-1395
Signed By Date
1/5/2022
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