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VIRGINIA CVS PHARMACY, L.L.C.
RWI23669A LGBT Life Center
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Covered Entity Details
Entity Name
LGBT Life Center
Subdivision Name
Type
Ryan White Part A
340B ID
RWI23669A
Entity Address
20 Settlers Landing Road
Hampton, VA 23669
Grant Number
H89HA00053
Participating Start Date
1/1/2024
Last Recertification Date
2/21/2025
Pharmacy Details
Pharmacy Name
VIRGINIA CVS PHARMACY, L.L.C.
Pharmacy Address
DBA CVS/PHARMACY # 6146
4261 E. LITTLE CREEK RD.
NORFOLK, VA 23518
Pharmacy Comments
Contract Details
Approval Date
10/31/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2024
Agreement registered in error
Contacts
Covered Entity Signing Official
Stacie Walls-Beegle, CEO
(757) 640-0929 Ext: 215
Contract Pharmacy Representative
CVS
Courtney Wilson, Representative
(817) 201-1395
Signed By Date
10/29/2023
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