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PROCARE PHARMACY, L.L.C.
STD921261 Planned Parenthood of the Pacific Southwest
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Covered Entity Details
Entity Name
Planned Parenthood of the Pacific Southwest
Subdivision Name
Mira Mesa
Type
Sexually Transmitted Diseases
340B ID
STD921261
Entity Address
10717 Camino Ruiz
Suite #258
San Diego, CA 92126
Grant Number
1H25PS005127
Participating Start Date
1/1/2016
Last Recertification Date
5/12/2025
Pharmacy Details
Pharmacy Name
PROCARE PHARMACY, L.L.C.
Pharmacy Address
DBA CVS/PHARMACY OR CARELONRX SPECIALTY
ONE WATERFRONT PLAZA
500 ALA MOANA BLVD., BLDG 1
HONOLULU, HI 96813
Pharmacy Comments
3/22/10 NAME CORRECTION (WAS CVS PROCARE PHARMACY DBA CVS PROCARE PHARMACY #2915) 3/17/10 ADDR CHANGE (WAS 970 N KALAHEO AVE, SUITE A 203)
Contract Details
Approval Date
10/11/2021
Contract Begin Date
1/1/2022
Carve-In Effective Date
Contract Comments
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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