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GRAND ST. PAUL CVS, L.L.C.
CH05696B SOUTHSIDE COMMUNITY HEALTH SERVICES
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Covered Entity Details
Entity Name
SOUTHSIDE COMMUNITY HEALTH SERVICES
Subdivision Name
Southside Medical Clinic
Type
HRSA-Funded Health Center
340B ID
CH05696B
Entity Address
324 E 35TH STREET
MINNEAPOLIS, MN 55408
Grant Number
H80CS00198
Participating Start Date
1/1/2005
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
GRAND ST. PAUL CVS, L.L.C.
Pharmacy Address
CVS PHARMACY # 16002
2555 W 79TH ST
BLOOMINGTON, MN 55431
Pharmacy Comments
Contract Details
Approval Date
10/11/2024
Contract Begin Date
1/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Ann Cazaban, Executive Director
(612) 821-2025
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
10/11/2024
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