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PROCARE PHARMACY, L.L.C.
STD482161 Health Emergency Lifeline Programs
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Covered Entity Details
Entity Name
Health Emergency Lifeline Programs
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD482161
Entity Address
1726 Howard Street
Detroit, MI 48216-1921
Grant Number
NH25PS005170
Participating Start Date
4/23/2020
Last Recertification Date
5/7/2024
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
7/13/2020
Contract Begin Date
10/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Tom Dunn, DHSP Operations Section Manager
(517) 335-7203
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
7/13/2020
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