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GERMAN DOBSON CVS, L.L.C.
STD85140 Institute for Liver Health
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Covered Entity Details
Entity Name
Institute for Liver Health
Subdivision Name
Flagstaff
Type
Sexually Transmitted Diseases
340B ID
STD85140
Entity Address
1150 North San Francisco St.
Flagstaff, AZ 86001
Grant Number
nu51ps005142
Participating Start Date
1/1/2022
Last Recertification Date
5/5/2025
Pharmacy Details
Pharmacy Name
GERMAN DOBSON CVS, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 03965
5975 W. CHANDLER BLVD.
CHANDLER, AZ 85226
Pharmacy Comments
Contract Details
Approval Date
10/17/2022
Contract Begin Date
10/17/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Anita Kohli, CEO
(434) 825-0921
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
10/17/2022
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