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GOODYEAR CVS, L.L.C.
CH093070 MOUNTAIN PARK HEALTH CENTER
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Covered Entity Details
Entity Name
MOUNTAIN PARK HEALTH CENTER
Subdivision Name
Mountain Park Health Center - Baseline
Type
HRSA-Funded Health Center
340B ID
CH093070
Entity Address
635 E Baseline Rd
Phoenix, AZ 85042-6551
Grant Number
H80CS00141
Participating Start Date
10/1/1996
Last Recertification Date
2/13/2025
Pharmacy Details
Pharmacy Name
GOODYEAR CVS, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 03749
2840 N. DYSART RD.
GOODYEAR, AZ 85395
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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