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WOODWARD DETROIT CVS, L.L.C.
CH05203AC CHERRY STREET SERVICES INC
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Covered Entity Details
Entity Name
CHERRY STREET SERVICES INC
Subdivision Name
Godwin Heights Senior High School Health Center
Type
HRSA-Funded Health Center
340B ID
CH05203AC
Entity Address
50 35th St SW
RM 100
Grand Rapids, MI 49548-2100
Grant Number
H80CS00770
Participating Start Date
1/1/2025
Last Recertification Date
2/24/2025
Pharmacy Details
Pharmacy Name
WOODWARD DETROIT CVS, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 08292
1155 FULLER AVE NE
GRAND RAPIDS, MI 49503
Pharmacy Comments
Contract Details
Approval Date
10/15/2024
Contract Begin Date
1/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Tasha Blackmon, CEO
(616) 965-8215
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
10/14/2024
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