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PROCARE PHARMACY, L.L.C.
STD322021 Positive Health Alliance, Inc
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Covered Entity Details
Entity Name
Positive Health Alliance, Inc
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD322021
Entity Address
720 N Ocean Street
Jacksonville, FL 32202
Grant Number
NH25PS005131
Participating Start Date
5/8/2020
Last Recertification Date
5/28/2021
Entity Termination Date
7/1/2022
Pharmacy Details
Pharmacy Name
PROCARE PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY #2909
1521 4TH AVE., SOUTH
BIRMINGHAM, AL 35233
Pharmacy Comments
Contract Details
Approval Date
7/14/2020
Contract Begin Date
10/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/4/2020
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Gary G Kogan, Executive Director
(888) 752-2267
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
7/14/2020
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