Contract Pharmacy Details

AMERICAN DRUG STORES DELAWARE, L.L.C.
RRC350070-00 INNOVIS HEALTH

Covered Entity Details

Entity Name

INNOVIS HEALTH

Subdivision Name

Type

Rural Referral Center

340B ID

RRC350070-00

Entity Address

3000 32ND AVENUE S
FARGO, ND 58103

Medicare Provider Number

350070

Participating Start Date

4/1/2022

Last Recertification Date

9/9/2024

Pharmacy Details

Pharmacy Name

AMERICAN DRUG STORES DELAWARE, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 08612
2425 13TH AVENUE SOUTH
FARGO, ND 58103

Pharmacy Comments

Contract Details

Approval Date

10/19/2022

Contract Begin Date

1/1/2023

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Al Hurley, COO
(701) 364-7667

Contract Pharmacy Representative

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

Signed By Date

10/19/2022

340B Drug Pricing Program Database