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ARIZONA CVS STORES, L.L.C.
FQHCLA225 Maricopa County Special Health Care District
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Covered Entity Details
Entity Name
Maricopa County Special Health Care District
Subdivision Name
Type
Health Center Program Look-Alike
340B ID
FQHCLA225
Entity Address
2601 E. ROOSEVELT STREET
PHOENIX, AZ 85008
Grant Number
LALCS00037
Participating Start Date
10/1/2007
Last Recertification Date
2/15/2019
Entity Termination Date
4/1/2020
Pharmacy Details
Pharmacy Name
ARIZONA CVS STORES, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 08914
50 W. JEFFERSON ST., SUITE 140
PHOENIX, AZ 85003
Pharmacy Comments
Contract Details
Approval Date
4/17/2017
Contract Begin Date
7/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2020
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Kris Gaw, Chief Operating Officer
(602) 344-1258
Contract Pharmacy Representative
CVS Health
William Combes, 340B Vendor Operations Manager
(401) 770-8411
Signed By Date
4/17/2017
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