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NEVADA CVS PHARMACY, L.L.C.
CH094890 VENICE FAMILY CLINIC
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Covered Entity Details
Entity Name
VENICE FAMILY CLINIC
Subdivision Name
VENICE FAMILY CLINIC
Type
HRSA-Funded Health Center
340B ID
CH094890
Entity Address
604 Rose Ave
Venice, CA 90291-2767
Grant Number
H80CS04217
Participating Start Date
10/1/1997
Last Recertification Date
2/14/2025
Pharmacy Details
Pharmacy Name
NEVADA CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 00082
6432 LOSEE RD.
NORTH LAS VEGAS, NV 89086
Pharmacy Comments
Contract Details
Approval Date
4/16/2023
Contract Begin Date
5/9/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Mitesh G Popat, CEO
(310) 664-7901
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
4/16/2023
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