Contract Pharmacy Details

PROCARE PHARMACY, L.L.C.
STD20017 Washington Health Institute

Covered Entity Details

Entity Name

Washington Health Institute

Subdivision Name

Type

Sexually Transmitted Diseases

340B ID

STD20017

Entity Address

1140 Varnum Street NE
PMB; Suite # 203
Washington, DC 20017-2153

Grant Number

1NH25PS005133-01-00

Participating Start Date

7/1/2019

Last Recertification Date

5/7/2024

Pharmacy Details

Pharmacy Name

PROCARE PHARMACY, L.L.C.

Pharmacy Address

DBA CVS/PHARMACY # 02553
1117 WALNUT ST.
PHILADELPHIA, PA 19107

Pharmacy Comments

Contract Details

Approval Date

10/12/2020

Contract Begin Date

1/1/2021

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Jose Bordon, Chief Executive Officer
(240) 426-8890

Contract Pharmacy Representative

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

Signed By Date

10/12/2020

340B Drug Pricing Program Database