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PROCARE PHARMACY, L.L.C.
STD330501 Midway Specialty Care Center Inc
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Covered Entity Details
Entity Name
Midway Specialty Care Center Inc
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD330501
Entity Address
5701 Overseas Highway
Ste # 10
Marathon, FL 33050
Grant Number
NH25PS005131
Participating Start Date
4/1/2020
Last Recertification Date
5/12/2020
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
10/14/2020
Contract Begin Date
11/9/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2021
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Kathryn E Hayden, CFO
(772) 742-9276
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
10/14/2020
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