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GRAND ST. PAUL CVS, L.L.C.
CH0516700 CEDAR-RIVERSIDE PEOPLES CENTER
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Covered Entity Details
Entity Name
CEDAR-RIVERSIDE PEOPLES CENTER
Subdivision Name
CEDAR RIVERSIDE PEOPLE'S CENTER
Type
HRSA-Funded Health Center
340B ID
CH0516700
Entity Address
425 20th Ave S
Minneapolis, MN 55454-4400
Grant Number
H80CS00859
Participating Start Date
7/1/2004
Last Recertification Date
2/12/2025
Pharmacy Details
Pharmacy Name
GRAND ST. PAUL CVS, L.L.C.
Pharmacy Address
CVS PHARMACY #16780
749 APOLLO DR
LINO LAKES, MN 55014
Pharmacy Comments
Contract Details
Approval Date
10/26/2024
Contract Begin Date
1/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Ann Rogers, CEO
(612) 332-4973
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
10/26/2024
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