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CVS CAREMARK
CH091300 CANYONLANDS COMMUNITY HEALTH CARE
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Covered Entity Details
Entity Name
CANYONLANDS COMMUNITY HEALTH CARE
Subdivision Name
Canyonlands Healthcare - Lake Powell
Type
HRSA-Funded Health Center
340B ID
CH091300
Entity Address
467 VISTA AVENUE
PAGE, AZ 86040
Grant Number
H80CS00448
Participating Start Date
10/1/1998
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
CVS CAREMARK
Pharmacy Address
DBA CVS/CAREMARK OR CF# 11506
1 GREAT VALLEY BOULEVARD
WILKES BARRE, PA 18706
Pharmacy Comments
Contract Details
Approval Date
4/4/2022
Contract Begin Date
7/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Christopher Hansen, CEO
(928) 645-6600
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
4/4/2022
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