Contract Pharmacy Details

VIRGINIA CVS PHARMACY, L.L.C.
CHC10591-10 COMMUNITY CLINIC, INC., THE

Covered Entity Details

Entity Name

COMMUNITY CLINIC, INC., THE

Subdivision Name

Community Clinic Inc

Type

HRSA-Funded Health Center

340B ID

CHC10591-10

Entity Address

8630 Fenton Street
Suite 1204
Silver Spring, MD 20910-3806

Grant Number

H80CS10591

Participating Start Date

10/1/2014

Last Recertification Date

2/3/2022

Entity Termination Date

7/1/2022

Pharmacy Details

Pharmacy Name

VIRGINIA CVS PHARMACY, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 01397
1452 CHAIN BRIDGE ROAD
MCLEAN, VA 22101

Pharmacy Comments

Contract Details

Approval Date

1/18/2022

Contract Begin Date

4/1/2022

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

7/1/2022
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Sonya J. Bruton, CEO and President
(240) 839-5107

Contract Pharmacy Representative

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

Signed By Date

1/18/2022

340B Drug Pricing Program Database