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GRAND ST. PAUL CVS, L.L.C.
CH051770 INDIAN HEALTH BOARD OF MINNEAPOLIS INC
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Covered Entity Details
Entity Name
INDIAN HEALTH BOARD OF MINNEAPOLIS INC
Subdivision Name
INDIAN HEALTH BOARD OF MINNEAPOLIS, INC.
Type
HRSA-Funded Health Center
340B ID
CH051770
Entity Address
1315 E 24th St
Minneapolis, MN 55404-3975
Grant Number
H80CS00441
Participating Start Date
7/1/2001
Last Recertification Date
2/17/2025
Pharmacy Details
Pharmacy Name
GRAND ST. PAUL CVS, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 01683
5801 BROOKLYN BLVD.
BROOKLYN CENTER, MN 55429
Pharmacy Comments
Contract Details
Approval Date
10/10/2024
Contract Begin Date
1/1/2025
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
6/5/2025
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Patrick Rock, CEO/Medical Director
(612) 721-9856
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
10/10/2024
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