Contract Pharmacy Details

GERMAN DOBSON CVS, L.L.C.
CH093030 ADELANTE HEALTHCARE, INC.

Covered Entity Details

Entity Name

ADELANTE HEALTHCARE, INC.

Subdivision Name

Adelante Healthcare

Type

HRSA-Funded Health Center

340B ID

CH093030

Entity Address

3033 N. Central Ave.
Phoenix, AZ 85012-4403

Grant Number

H80CS00140

Participating Start Date

12/1/1992

Last Recertification Date

2/12/2025

Pharmacy Details

Pharmacy Name

GERMAN DOBSON CVS, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 01743
13870 W. GREENWAY RD.
SURPRISE, AZ 85374

Pharmacy Comments

Contract Details

Approval Date

4/7/2015

Contract Begin Date

7/1/2015

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

12/31/2016
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Richard Miller, CFO
(623) 583-3001

Contract Pharmacy Representative

CVS Caremark
JACKLYN PARFITT, MANAGER, PAYER RELATIONS
(401) 770-6467

Signed By Date

4/7/2015

340B Drug Pricing Program Database