Contract Pharmacy Details

PROCARE PHARMACY, L.L.C.
STD323044 Positive Health Alliance, Inc.

Covered Entity Details

Entity Name

Positive Health Alliance, Inc.

Subdivision Name

Type

Sexually Transmitted Diseases

340B ID

STD323044

Entity Address

2121 W. Pensacola Street
B2
Tallahassee, FL 32304

Grant Number

NH25PS005131

Participating Start Date

8/18/2020

Last Recertification Date

Entity Termination Date

7/1/2021

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

8/7/2020

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

7/15/2020

340B Drug Pricing Program Database