Contract Pharmacy Details

PROCARE PHARMACY, L.L.C.
RWII761111 AIDS HEALTHCARE FOUNDATION

Covered Entity Details

Entity Name

AIDS HEALTHCARE FOUNDATION

Subdivision Name

AHF HEALTHCARE CENTER FORT WORTH

Type

Ryan White Part B

340B ID

RWII761111

Entity Address

400 N. BEACH STREET SUITE 104
FORT WORTH, TX 76111

Grant Number

X07HA00054

Participating Start Date

1/1/2016

Last Recertification Date

2/26/2024

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

7/13/2022

Contract Begin Date

10/1/2022

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

4/1/2025
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Rena DeStefano, Director of Pharmacy Finance
(631) 370-2022

Contract Pharmacy Representative

CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782

Signed By Date

7/13/2022

340B Drug Pricing Program Database