Contract Pharmacy Details

ARIZONA CVS STORES, L.L.C.
CHC28956-01 Valle Del Sol, Inc.

Covered Entity Details

Entity Name

Valle Del Sol, Inc.

Subdivision Name

Valle del Sol_502

Type

HRSA-Funded Health Center

340B ID

CHC28956-01

Entity Address

502 N 27th Ave
Phoenix, AZ 85009-4420

Grant Number

H80CS28956

Participating Start Date

1/1/2022

Last Recertification Date

2/17/2025

Pharmacy Details

Pharmacy Name

ARIZONA CVS STORES, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 03383
7550 SOUTH 19TH AVE.
PHOENIX, AZ 85041

Pharmacy Comments

Contract Details

Approval Date

4/4/2024

Contract Begin Date

7/1/2024

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Mike Renaud, President & Chief Executive Officer
(602) 258-6797 Ext: 1320

Contract Pharmacy Representative

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

Signed By Date

4/4/2024

340B Drug Pricing Program Database