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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
6 NU62PS924550-05-06
Participating Start Date
4/1/2021
Last Recertification Date
5/15/2024
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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