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GRAND ST. PAUL CVS, L.L.C.
DSH240106 REGIONS HOSPITAL
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Covered Entity Details
Entity Name
REGIONS HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH240106
Entity Address
640 JACKSON ST.
ST. PAUL, MN 55101
Medicare Provider Number
240106
Participating Start Date
12/1/1992
Last Recertification Date
8/21/2024
Pharmacy Details
Pharmacy Name
GRAND ST. PAUL CVS, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 01683
5801 BROOKLYN BLVD.
BROOKLYN CENTER, MN 55429
Pharmacy Comments
Contract Details
Approval Date
4/1/2024
Contract Begin Date
7/1/2024
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/30/2025
Pharmacy closed
Contacts
Covered Entity Signing Official
John M Clark, VP Finance
(651) 254-0900
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
4/1/2024
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