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PROCARE PHARMACY, L.L.C.
STD20785 Washington Health Institute
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Covered Entity Details
Entity Name
Washington Health Institute
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD20785
Entity Address
8240 Professional Place
Suite 207B
Landover, MD 20785
Grant Number
6NU65PS004902-05-07
Participating Start Date
12/30/2020
Last Recertification Date
5/4/2021
Entity Termination Date
7/1/2022
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
1/5/2021
Contract Begin Date
4/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2022
Covered Entity Terminated
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
1/5/2021
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