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PROCARE PHARMACY, L.L.C.
CH066580 Centro San Vicente
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Covered Entity Details
Entity Name
Centro San Vicente
Subdivision Name
None
Type
HRSA-Funded Health Center
340B ID
CH066580
Entity Address
8061 Alameda Ave
El Paso, TX 79915-4705
Grant Number
H80CS00637
Participating Start Date
10/1/1995
Last Recertification Date
3/4/2025
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
10/4/2021
Contract Begin Date
1/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Christina Ilene Paz, CEO
(915) 859-7545 Ext: 1232
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
10/4/2021
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