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ARIZONA CVS STORES, L.L.C.
STD85004 Prisma Community Care
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Covered Entity Details
Entity Name
Prisma Community Care
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD85004
Entity Address
1101 N Central Ave
Suite 200
Phoenix, AZ 85004
Grant Number
5 NU62PS924676-03-00
Participating Start Date
1/1/2019
Last Recertification Date
5/8/2024
Pharmacy Details
Pharmacy Name
ARIZONA CVS STORES, L.L.C.
Pharmacy Address
DBA CVS/PHARMACY # 8983
5125 W. OLIVE AVE
GLENDALE, AZ 85302
Pharmacy Comments
Contract Details
Approval Date
7/1/2024
Contract Begin Date
10/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jessyca Leach, Executive Director
(602) 595-8115
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
7/1/2024
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