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PROCARE PHARMACY, L.L.C.
STD921095 Planned Parenthood of the Pacific Southwest
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Covered Entity Details
Entity Name
Planned Parenthood of the Pacific Southwest
Subdivision Name
Mission Bay
Type
Sexually Transmitted Diseases
340B ID
STD921095
Entity Address
4501 Mission Bay Drive #1C&D
San Diego, CA 92109
Grant Number
1H25PS005127
Participating Start Date
1/1/2016
Last Recertification Date
5/21/2024
Entity Termination Date
4/1/2025
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
10/11/2021
Contract Begin Date
1/1/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2025
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Darrah Johnson, CEO
(619) 881-5050 Ext: 6198815050
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
10/11/2021
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