Contract Pharmacy Details

GRAND ST. PAUL CVS, L.L.C.
RWI89102 Horizon Ridge Clinic LLC

Covered Entity Details

Entity Name

Horizon Ridge Clinic LLC

Subdivision Name

Type

Ryan White Part A

340B ID

RWI89102

Entity Address

1670 E Flamingo Road
Suite A
Las Vegas, NV 89119

Grant Number

H89HA06900

Participating Start Date

7/1/2018

Last Recertification Date

2/2/2022

Entity Termination Date

1/1/2023

Pharmacy Details

Pharmacy Name

GRAND ST. PAUL CVS, L.L.C.

Pharmacy Address

CVS PHARMACY # 16565
1370 HIGHWAY 15 S
HUTCHINSON, MN 55350

Pharmacy Comments

Contract Details

Approval Date

4/9/2022

Contract Begin Date

5/6/2022

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

1/1/2023
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Bruce Eddins, Chief Administrator
(702) 489-2889 Ext: 102

Contract Pharmacy Representative

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

Signed By Date

4/9/2022

340B Drug Pricing Program Database