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PROCARE PHARMACY, L.L.C.
FQHCLA247 HEALTH AND LIFE ORGANIZATION INC.
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Covered Entity Details
Entity Name
HEALTH AND LIFE ORGANIZATION INC.
Subdivision Name
SACRAMENTO COMMUNITY CLINIC - SOUTHGATE
Type
Health Center Program Look-Alike
340B ID
FQHCLA247
Entity Address
7275 E. SOUTHGATE DRIVE
SUITE 204
SACRAMENTO, CA 95823
Grant Number
LALCS00018
Participating Start Date
4/1/2009
Last Recertification Date
1/31/2023
Entity Termination Date
10/1/2023
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
1/13/2022
Contract Begin Date
4/1/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2023
Covered Entity Terminated
Contacts
Covered Entity Signing Official
JERRY T. BLIATOUT, CEO
(916) 428-3788 Ext: 4236
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
1/13/2022
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