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UTAH CVS PHARMACY, L.L.C.
DSH460009 University of Utah
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Covered Entity Details
Entity Name
University of Utah
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH460009
Entity Address
50 North Medical Drive
Salt Lake City, UT 84132
Medicare Provider Number
460009
Participating Start Date
7/1/1996
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
UTAH CVS PHARMACY, L.L.C.
Pharmacy Address
CVS PHARMACY # 17596
1110 S 300 W
SALT LAKE CITY, UT 84101
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
Charlton Gordon Park, Chief Financial Officer
(801) 585-1325
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
7/17/2023
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