Contract Pharmacy Details

PROCARE PHARMACY, L.L.C.
RWII16214 Pennsylvania Western University

Covered Entity Details

Entity Name

Pennsylvania Western University

Subdivision Name

PA Thrive Partnership

Type

Ryan White Part B

340B ID

RWII16214

Entity Address

867 E Main St
Suite 209
Clarion, PA 16214

Grant Number

X07HA00021

Participating Start Date

7/1/2016

Last Recertification Date

2/10/2025

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

1/15/2021

Contract Begin Date

4/1/2021

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

4/1/2022
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Amy Heather Esterhuizen, GRANTS OFFICER
(814) 393-2162

Contract Pharmacy Representative

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

Signed By Date

1/15/2021

340B Drug Pricing Program Database