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PROCARE PHARMACY, L.L.C.
RWI19147 Mazzoni Center
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Covered Entity Details
Entity Name
Mazzoni Center
Subdivision Name
Type
Ryan White Part A
340B ID
RWI19147
Entity Address
1348 Bainbridge Street
Philadelphia, PA 19147-1810
Grant Number
H89HA00013
Participating Start Date
4/1/2018
Last Recertification Date
2/17/2025
Pharmacy Details
Pharmacy Name
PROCARE PHARMACY, L.L.C.
Pharmacy Address
DBA CVS/PHARMACY # 02553
1117 WALNUT ST.
PHILADELPHIA, PA 19107
Pharmacy Comments
Contract Details
Approval Date
10/11/2018
Contract Begin Date
1/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
5/18/2021
Pharmacy closed
Contacts
Covered Entity Signing Official
Ronald Powers, COO
(215) 563-0652 Ext: 210
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
10/11/2018
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