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MISSOURI CVS PHARMACY, L.L.C.
STD66205 Doc Shop, P.A.
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Covered Entity Details
Entity Name
Doc Shop, P.A.
Subdivision Name
Doc Shop, P.A.
Type
Sexually Transmitted Diseases
340B ID
STD66205
Entity Address
5407 Johnson Drive
Street
Mission, KS 66205
Grant Number
NH25PS005173
Participating Start Date
10/1/2022
Last Recertification Date
5/7/2024
Pharmacy Details
Pharmacy Name
MISSOURI CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 08566
5310 BLUERIDGE BLVD.
RAYTOWN, MO 64133
Pharmacy Comments
Contract Details
Approval Date
1/12/2024
Contract Begin Date
4/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Sharon D Lee, President
(913) 961-6971
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
1/12/2024
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