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GRAND ST. PAUL CVS, L.L.C.
CH0510280 LAKE SUPERIOR COMMUNITY HEALTH CENTER
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Covered Entity Details
Entity Name
LAKE SUPERIOR COMMUNITY HEALTH CENTER
Subdivision Name
LAKE SUPERIOR HEALTH CENTER
Type
HRSA-Funded Health Center
340B ID
CH0510280
Entity Address
4325 Grand Ave
Duluth, MN 55807-2730
Grant Number
H80CS00811
Participating Start Date
10/1/2000
Last Recertification Date
2/21/2025
Pharmacy Details
Pharmacy Name
GRAND ST. PAUL CVS, L.L.C.
Pharmacy Address
DBA CVS/PHARMACY #6691
1215 E SUPERIOR STREET
DULUTH, MN 55802
Pharmacy Comments
Contract Details
Approval Date
10/14/2024
Contract Begin Date
1/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Lee Homan, CEO
(218) 336-3503
Contract Pharmacy Representative
CVS
Christian Reid, 340B Program Director
(401) 770-2118
Signed By Date
10/14/2024
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