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VIRGINIA CVS PHARMACY, L.L.C.
STD23669 LGBT Life Center
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Covered Entity Details
Entity Name
LGBT Life Center
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD23669
Entity Address
20 Settlers Landing
Hampton, VA 23669
Grant Number
5NU62PS924750-04-00
Participating Start Date
1/1/2025
Last Recertification Date
Pharmacy Details
Pharmacy Name
VIRGINIA CVS PHARMACY, L.L.C.
Pharmacy Address
DBA CVS/PHARMACY # 4520
1800 FREDERICK BLVD.
PORTSMOUTH, VA 23707
Pharmacy Comments
Contract Details
Approval Date
11/20/2024
Contract Begin Date
1/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Stacie Walls-Beegle, CEO
(757) 640-0929 Ext: 215
Contract Pharmacy Representative
CVS
Courtney Wilson, Representative
(817) 201-1395
Signed By Date
10/15/2024
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