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VIRGINIA CVS PHARMACY, L.L.C.
CH034180 SOUTHERN DOMINION HEALTH SYSTEMS, INC.
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Covered Entity Details
Entity Name
SOUTHERN DOMINION HEALTH SYSTEMS, INC.
Subdivision Name
ADMINISTRATIVE OFFICE
Type
HRSA-Funded Health Center
340B ID
CH034180
Entity Address
1508 K-V ROAD
VICTORIA, VA 23974
Grant Number
H80CS00173
Participating Start Date
12/1/1992
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
VIRGINIA CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 03915
610 N MAIN ST
CHASE CITY, VA 23924
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
April King, CEO
(434) 696-2165 Ext: 212
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
7/14/2023
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