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NORTH CAROLINA CVS PHARMACY, L.L.C.
RWII27604A The Alliance of AIDS Services - Carolina
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Covered Entity Details
Entity Name
The Alliance of AIDS Services - Carolina
Subdivision Name
N/A
Type
Ryan White Part B
340B ID
RWII27604A
Entity Address
3109 Poplarwood Ct
Suite 200
Raleigh, NC 27604
Grant Number
X07HA00051
Participating Start Date
7/1/2021
Last Recertification Date
2/12/2025
Pharmacy Details
Pharmacy Name
NORTH CAROLINA CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 04198
3914 CAPITAL BLVD
RALEIGH, NC 27604
Pharmacy Comments
Contract Details
Approval Date
2/9/2023
Contract Begin Date
2/9/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Tiffany Hickman, Executive Director
(919) 834-2734
Contract Pharmacy Representative
wellpartner
Crissy Levisay, Account Manager
(239) 322-4188
Signed By Date
2/9/2023
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