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NEVADA CVS PHARMACY, L.L.C.
STD891065 LifeCare Partners
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Covered Entity Details
Entity Name
LifeCare Partners
Subdivision Name
NKDHC Northeast Office
Type
Sexually Transmitted Diseases
340B ID
STD891065
Entity Address
1581 Mount Mariah Dr.
#150
Las Vegas, NV 89106
Grant Number
NH25PS005179-05-04
Participating Start Date
7/1/2024
Last Recertification Date
Entity Termination Date
7/1/2025
Pharmacy Details
Pharmacy Name
NEVADA CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 08824
4411 E. BONANZA RD
LAS VEGAS, NV 89110
Pharmacy Comments
Contract Details
Approval Date
6/12/2024
Contract Begin Date
7/1/2024
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2025
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Vladimir Abadjiev, COO
(702) 526-3146
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
4/15/2024
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