Contract Pharmacy Details

GRAND ST. PAUL CVS, L.L.C.
STD89119 Horizon Ridge Wellness Clinic, Inc

Covered Entity Details

Entity Name

Horizon Ridge Wellness Clinic, Inc

Subdivision Name

Type

Sexually Transmitted Diseases

340B ID

STD89119

Entity Address

1670 E Flamingo Road, Suite A
Suite A
Las Vegas, NV 89119

Grant Number

5NH25PS005179-04-00

Participating Start Date

6/3/2022

Last Recertification Date

6/4/2024

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

6/3/2022

Contract Begin Date

7/1/2022

Carve-In Effective Date

Contract Comments

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

5/19/2022

340B Drug Pricing Program Database