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PROCARE PHARMACY, L.L.C.
RWI48216 Health Emergency Lifeline Program
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Covered Entity Details
Entity Name
Health Emergency Lifeline Program
Subdivision Name
Type
Ryan White Part A
340B ID
RWI48216
Entity Address
1726 Howard St
Detroit, MI 48216
Grant Number
H89HA00021
Participating Start Date
1/1/2016
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
PROCARE PHARMACY, L.L.C.
Pharmacy Address
DBA CVS/PHARMACY #2923
3250 HARDEN ST. EXT. SUITE #300
COLUMBIA, SC 29203
Pharmacy Comments
Contract Details
Approval Date
7/1/2020
Contract Begin Date
10/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Anthony Williams, Chief Executive Officer
(313) 832-3300 Ext: 215
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
7/1/2020
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