Contract Pharmacy Details

GERMAN DOBSON CVS, L.L.C.
DSH030002 Banner – University Medical Center Phoenix

Covered Entity Details

Entity Name

Banner – University Medical Center Phoenix

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH030002

Entity Address

1111 EAST MCDOWELL ROAD
PHOENIX, AZ 85006

Medicare Provider Number

030002

Participating Start Date

9/9/2005

Last Recertification Date

8/12/2024

Pharmacy Details

Pharmacy Name

GERMAN DOBSON CVS, L.L.C.

Pharmacy Address

CVS PHARMACY # 17463
995 S COTTON LN
GOODYEAR, AZ 85338

Pharmacy Comments

Contract Details

Approval Date

7/17/2023

Contract Begin Date

10/1/2023

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Diana L Gernhart, Chief Financial Officer
(602) 839-8507

Contract Pharmacy Representative

Caremark L.L.C.
Christian reid, 340b Program Director
(401) 770-2118

Signed By Date

7/17/2023

340B Drug Pricing Program Database