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ARIZONA CVS STORES, L.L.C.
STD86305 Northland Cares
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Covered Entity Details
Entity Name
Northland Cares
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD86305
Entity Address
Northland Cares
3188 N Windsong Drive
A
Prescott Valley, AZ 86314
Grant Number
6 NU62PS924550-05-06
Participating Start Date
10/1/2019
Last Recertification Date
5/13/2024
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
7/11/2024
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
7/11/2024
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