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ARIZONA CVS STORES, L.L.C.
STD85382 Institute for Liver Health
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Covered Entity Details
Entity Name
Institute for Liver Health
Subdivision Name
Peoria
Type
Sexually Transmitted Diseases
340B ID
STD85382
Entity Address
15396 N 83rd Avenue
Bldg E
Peoria, AZ 85381
Grant Number
nu51ps005142
Participating Start Date
1/1/2022
Last Recertification Date
5/5/2025
Pharmacy Details
Pharmacy Name
ARIZONA CVS STORES, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 09231
3506 EAST ROUTE 66
FLAGSTAFF, AZ 86004
Pharmacy Comments
Contract Details
Approval Date
1/15/2024
Contract Begin Date
4/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Anita Kohli, CEO
(434) 825-0921
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
1/15/2024
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