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ARIZONA CVS STORES, L.L.C.
RWII86305 Northland Cares
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Covered Entity Details
Entity Name
Northland Cares
Subdivision Name
Northland Cares
Type
Ryan White Part B
340B ID
RWII86305
Entity Address
3188 N Windsong Drive
Suite A
Prescott Valley, AZ 86314
Grant Number
X07HA00080
Participating Start Date
7/1/2013
Last Recertification Date
2/27/2025
Pharmacy Details
Pharmacy Name
ARIZONA CVS STORES, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 08977
3501 STOCKTON HILL RD.
KINGMAN, AZ 86409
Pharmacy Comments
Contract Details
Approval Date
7/10/2024
Contract Begin Date
10/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Johnny Martinez, Executive Director
(928) 776-4612
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
7/10/2024
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