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GERMAN DOBSON CVS, L.L.C.
CH09307T Mountain Park Health Center
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Covered Entity Details
Entity Name
Mountain Park Health Center
Subdivision Name
Mountain Park Health Center - Goodyear Suite 100
Type
HRSA-Funded Health Center
340B ID
CH09307T
Entity Address
140 N Litchfield Rd Ste 100
Goodyear, AZ 85338-1269
Grant Number
H80CS00141
Participating Start Date
7/1/2022
Last Recertification Date
2/13/2025
Pharmacy Details
Pharmacy Name
GERMAN DOBSON CVS, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 06718
5835 W. INDIAN SCHOOL RD.
PHOENIX, AZ 85031
Pharmacy Comments
Contract Details
Approval Date
4/12/2024
Contract Begin Date
7/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
John R. Swagert, CEO
(602) 323-3470
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
4/12/2024
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