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PROCARE PHARMACY, L.L.C.
FQHCLA298 Centro Medico Community Clinic, Inc.
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Covered Entity Details
Entity Name
Centro Medico Community Clinic, Inc.
Subdivision Name
Type
Health Center Program Look-Alike
340B ID
FQHCLA298
Entity Address
1303 W 6th St
105
Corona, CA 92882
Grant Number
LALCS00062
Participating Start Date
7/1/2012
Last Recertification Date
2/19/2025
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
10/14/2021
Contract Begin Date
1/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Andy Piskoulian, CEO
(951) 278-8910
Contract Pharmacy Representative
Wellpartner, a CVS Health Company
Alyssa Felton, Consultant, Account Manager
(480) 586-7265
Signed By Date
10/14/2021
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