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GRAND ST. PAUL CVS, L.L.C.
CH053020 WEST SIDE COMMUNITY HEALTH SERVICES, INC.
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Covered Entity Details
Entity Name
WEST SIDE COMMUNITY HEALTH SERVICES, INC.
Subdivision Name
WESTSIDE COMMUNITY HEALTH SERVICES, INC.
Type
HRSA-Funded Health Center
340B ID
CH053020
Entity Address
153 Cesar Chavez St
Saint Paul, MN 55107-2226
Grant Number
H80CS00790
Participating Start Date
1/1/1997
Last Recertification Date
2/14/2025
Pharmacy Details
Pharmacy Name
GRAND ST. PAUL CVS, L.L.C.
Pharmacy Address
CVS PHARMACY # 16508
3300 124TH AVE NW
COON RAPIDS, MN 55433
Pharmacy Comments
Contract Details
Approval Date
10/7/2022
Contract Begin Date
1/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Reuben Moore, President and Executive Officer
(651) 602-7536
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
10/7/2022
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