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PENNSYLVANIA CVS PHARMACY, L.L.C.
STD18702 WYOMING VALLEY AIDS COUNCIL, INC.
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Covered Entity Details
Entity Name
WYOMING VALLEY AIDS COUNCIL, INC.
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD18702
Entity Address
330 BOWMAN STREET
UNIT 1
WILKES-BARRE, PA 18702
Grant Number
NH25PS005144-05-06
Participating Start Date
1/1/2019
Last Recertification Date
5/6/2024
Pharmacy Details
Pharmacy Name
PENNSYLVANIA CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 01593
110 GREEN RIDGE STREET
SCRANTON, PA 18509
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
KEN J ZULA, EXECUTIVE DIRECTOR
(570) 823-5808 Ext: 302
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
4/4/2022
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