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ARIZONA CVS STORES, L.L.C.
STD86326 Northland Cares
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Covered Entity Details
Entity Name
Northland Cares
Subdivision Name
Cottonwood
Type
Sexually Transmitted Diseases
340B ID
STD86326
Entity Address
203 S. Candy Lane, Suite 3AB
Cottonwood, AZ 86326
Grant Number
NU62PS924818
Participating Start Date
4/1/2021
Last Recertification Date
5/9/2025
Pharmacy Details
Pharmacy Name
ARIZONA CVS STORES, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 09266
522 W FINNIE FLAT ROAD
CAMP VERDE, AZ 86322
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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