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NORTH CAROLINA CVS PHARMACY, L.L.C.
STD27604 Alliance of AIDS Services-Carolina
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Covered Entity Details
Entity Name
Alliance of AIDS Services-Carolina
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD27604
Entity Address
3109 Poplarwood Ct.
200
Raleigh, NC 27604
Grant Number
6NH25PS005152-05-07
Participating Start Date
10/1/2018
Last Recertification Date
5/5/2025
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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