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GRAND ST. PAUL CVS, L.L.C.
STD551141 Rainbow Health Minnesota
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Covered Entity Details
Entity Name
Rainbow Health Minnesota
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD551141
Entity Address
701 S 4th Ave
Ste. 1500
Minneapolis, MN 55415
Grant Number
6 NH25PS005172
Participating Start Date
10/1/2023
Last Recertification Date
5/6/2024
Pharmacy Details
Pharmacy Name
GRAND ST. PAUL CVS, L.L.C.
Pharmacy Address
CVS PHARMACY # 17671
1329 5TH STREET SE
MINNEAPOLIS, MN 55414
Pharmacy Comments
Contract Details
Approval Date
12/22/2022
Contract Begin Date
12/22/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2023
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Jeremy James Hanson Willis, CEO
(612) 373-2400 Ext: 6123065274
Contract Pharmacy Representative
CVS
Alex Hazard, Account Manager
(315) 886-5406
Signed By Date
12/22/2022
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