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ARIZONA CVS STORES, L.L.C.
STD857121 Institute for Liver Health
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Covered Entity Details
Entity Name
Institute for Liver Health
Subdivision Name
Tucson
Type
Sexually Transmitted Diseases
340B ID
STD857121
Entity Address
1601 N Swan Road
Tucson, AZ 85712
Grant Number
nu51ps005142
Participating Start Date
1/1/2022
Last Recertification Date
5/22/2024
Pharmacy Details
Pharmacy Name
ARIZONA CVS STORES, L.L.C.
Pharmacy Address
DBA CVS/PHARMACY # 8983
5125 W. OLIVE AVE
GLENDALE, AZ 85302
Pharmacy Comments
Contract Details
Approval Date
7/14/2023
Contract Begin Date
10/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Anita Kohli, CEO
(434) 825-0921
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
7/14/2023
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