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PROCARE PHARMACY, L.L.C.
STD02879 CODAC Behavioral Healthcare Inc
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Covered Entity Details
Entity Name
CODAC Behavioral Healthcare Inc
Subdivision Name
CODAC South County
Type
Sexually Transmitted Diseases
340B ID
STD02879
Entity Address
350 Columbia St
Wakefield, RI 02879
Grant Number
6 NH25PS0005160-02
Participating Start Date
7/1/2021
Last Recertification Date
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
4/26/2021
Contract Begin Date
7/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2021
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Linda Hurley, CEO
(401) 275-5037
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
4/15/2021
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