Contract Pharmacy Details

PROCARE PHARMACY, L.L.C.
STD96793 Maui A.I.D.S. Foundation

Covered Entity Details

Entity Name

Maui A.I.D.S. Foundation

Subdivision Name

Type

Sexually Transmitted Diseases

340B ID

STD96793

Entity Address

1935 Main St.
Suite 101
Wailuku, HI 96793

Grant Number

NH25PS005136

Participating Start Date

10/1/2018

Last Recertification Date

5/13/2024

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

7/6/2020

Contract Begin Date

10/1/2020

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Chasity Cadaoas, Executive Director
(808) 242-4900

Contract Pharmacy Representative

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

Signed By Date

7/6/2020

340B Drug Pricing Program Database