Contract Pharmacy Details

GRAND ST. PAUL CVS, L.L.C.
CH097880 PETALUMA HEALTH CENTER, INC

Covered Entity Details

Entity Name

PETALUMA HEALTH CENTER, INC

Subdivision Name

Petaluma Health Center

Type

HRSA-Funded Health Center

340B ID

CH097880

Entity Address

1179 N. McDowell Blvd.
Petaluma, CA 94954-6559

Grant Number

H80CS00587

Participating Start Date

7/1/2000

Last Recertification Date

2/10/2025

Pharmacy Details

Pharmacy Name

GRAND ST. PAUL CVS, L.L.C.

Pharmacy Address

CVS PHARMACY # 16353
2021 MARKET DR
STILLWATER, MN 55082

Pharmacy Comments

Contract Details

Approval Date

7/7/2023

Contract Begin Date

10/1/2023

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Molly Jouaneh, Chief Financial Officer
(707) 559-7500

Contract Pharmacy Representative

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

Signed By Date

7/7/2023

340B Drug Pricing Program Database