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PROCARE PHARMACY, L.L.C.
FQHCLA358 Equitas Health, Inc.
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Covered Entity Details
Entity Name
Equitas Health, Inc.
Subdivision Name
Equitas Health Short North
Type
Health Center Program Look-Alike
340B ID
FQHCLA358
Entity Address
1033 N High St
Columbus, OH 43201
Grant Number
LALCS31539
Participating Start Date
1/1/2018
Last Recertification Date
2/12/2025
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
10/8/2020
Contract Begin Date
1/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Nick Saltman, Interim Chief Pharmacy Officer
(614) 987-5621
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
10/8/2020
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