Contract Pharmacy Details

PROCARE PHARMACY, L.L.C.
RWI75219 Resource Center of Dallas

Covered Entity Details

Entity Name

Resource Center of Dallas

Subdivision Name

Type

Ryan White Part A

340B ID

RWI75219

Entity Address

2603 Inwood
Dallas, TX 75235

Grant Number

H89HA00002

Participating Start Date

7/1/2015

Last Recertification Date

2/10/2025

Pharmacy Details

Pharmacy Name

PROCARE PHARMACY, L.L.C.

Pharmacy Address

DBA CVS/PHARMACY #2751
426 S. HENDERSON STREET
FORT WORTH, TX 76104

Pharmacy Comments

Contract Details

Approval Date

7/3/2018

Contract Begin Date

10/1/2018

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Marisa Elliott, Chief Operating Officer
(214) 540-4454

Contract Pharmacy Representative

CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782

Signed By Date

7/3/2018

340B Drug Pricing Program Database