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GRAND ST. PAUL CVS, L.L.C.
DSH240038 United Hospital
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Covered Entity Details
Entity Name
United Hospital
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH240038
Entity Address
333 North Smith Ave
St Paul, MN 55102
Medicare Provider Number
240038
Participating Start Date
10/1/2013
Last Recertification Date
8/12/2024
Pharmacy Details
Pharmacy Name
GRAND ST. PAUL CVS, L.L.C.
Pharmacy Address
CVS PHARMACY # 17138
1750 ROBERT ST S
WEST ST PAUL, MN 55118
Pharmacy Comments
Contract Details
Approval Date
10/11/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Tony M Collins-Kwong, Director, Strategic Sourcing and Services, Pharmacy Services
(612) 262-4785
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
10/11/2023
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