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ARIZONA CVS STORES, L.L.C.
STD85225 Institute for Liver Health
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Covered Entity Details
Entity Name
Institute for Liver Health
Subdivision Name
McQueen
Type
Sexually Transmitted Diseases
340B ID
STD85225
Entity Address
910 E. Pecos Rd.
Chandler, AZ 85225
Grant Number
NU51PS005142
Participating Start Date
10/1/2024
Last Recertification Date
5/5/2025
Pharmacy Details
Pharmacy Name
ARIZONA CVS STORES, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 09231
3506 EAST ROUTE 66
FLAGSTAFF, AZ 86004
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
Anita Kohli, CEO
(434) 825-0921
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
10/15/2024
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