Contract Pharmacy Details

PROCARE PHARMACY, L.L.C.
RWII60608 Alliance Care 360

Covered Entity Details

Entity Name

Alliance Care 360

Subdivision Name

Type

Ryan White Part B

340B ID

RWII60608

Entity Address

2929 S Wabash Avenue
Suite
202
Chicago, IL 60616-2327

Grant Number

X07HA00013-27-00

Participating Start Date

4/1/2016

Last Recertification Date

2/14/2025

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

7/13/2020

Contract Begin Date

10/1/2020

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

1/29/2021
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Ariq Cabbler, Director
(312) 808-1044 Ext: 101

Contract Pharmacy Representative

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

Signed By Date

7/13/2020

340B Drug Pricing Program Database