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GRAND ST. PAUL CVS, L.L.C.
TB55415 Hennepin County
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Covered Entity Details
Entity Name
Hennepin County
Subdivision Name
Hennepin County Public Health Clinic
Type
Tuberculosis
340B ID
TB55415
Entity Address
525 Portland Avenue
MC 952
Minneapolis, MN 55415
Grant Number
1NU52PS910308
Participating Start Date
4/1/2013
Last Recertification Date
5/17/2024
Pharmacy Details
Pharmacy Name
GRAND ST. PAUL CVS, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 01129
4152 LAKELAND AVE. NORTH
ROBBINSDALE, MN 55422
Pharmacy Comments
Contract Details
Approval Date
10/1/2024
Contract Begin Date
1/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Mary Jo LaCroix Meuleners, Clinic Manager
(612) 348-3283
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
10/1/2024
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