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PROCARE PHARMACY, L.L.C.
STD76110 Health Education Learning Project
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Covered Entity Details
Entity Name
Health Education Learning Project
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD76110
Entity Address
1717 S Main Street
Fort Worth, TX 76110
Grant Number
NH25PS005182
Participating Start Date
4/1/2017
Last Recertification Date
5/8/2023
Entity Termination Date
7/1/2024
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
10/10/2018
Contract Begin Date
1/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2024
Covered Entity Terminated
Contacts
Covered Entity Signing Official
DeeJay Johannessen, Chief Executive Officer
(817) 332-7722
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
10/10/2018
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