Contract Pharmacy Details

ARIZONA CVS STORES, L.L.C.
STD85004 Prisma Community Care

Covered Entity Details

Entity Name

Prisma Community Care

Subdivision Name

Type

Sexually Transmitted Diseases

340B ID

STD85004

Entity Address

1101 N Central Ave
Suite 200
Phoenix, AZ 85004

Grant Number

5 NU62PS924676-03-00

Participating Start Date

1/1/2019

Last Recertification Date

5/8/2024

Pharmacy Details

Pharmacy Name

ARIZONA CVS STORES, L.L.C.

Pharmacy Address

CVS/PHARMACY #8952
24865 N. LAKE PLEASANT PARKWAY
PEORIA, AZ 85383

Pharmacy Comments

Contract Details

Approval Date

4/1/2024

Contract Begin Date

7/1/2024

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Jessyca Leach, Executive Director
(602) 595-8115

Contract Pharmacy Representative

CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782

Signed By Date

4/1/2024

340B Drug Pricing Program Database