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ARIZONA CVS STORES, L.L.C.
STD85392 TL Family Nurse Practice LLC
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Covered Entity Details
Entity Name
TL Family Nurse Practice LLC
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD85392
Entity Address
13055 West McDowell Road
E-101
Avondale, AZ 85392
Grant Number
NU51PS005142
Participating Start Date
7/1/2024
Last Recertification Date
Pharmacy Details
Pharmacy Name
ARIZONA CVS STORES, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 09312
4323 EAST BELL ROAD
PHOENIX, AZ 85032
Pharmacy Comments
Contract Details
Approval Date
5/15/2024
Contract Begin Date
7/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Tara Begay, FNP/ Co Owner
(602) 918-3225
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
4/15/2024
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