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PROCARE PHARMACY, L.L.C.
RWII55409 The Aliveness Project, Inc
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Covered Entity Details
Entity Name
The Aliveness Project, Inc
Subdivision Name
Type
Ryan White Part B
340B ID
RWII55409
Entity Address
3808 Nicollet Avenue
Minneapolis, MN 55409
Grant Number
X07HA00028
Participating Start Date
1/1/2015
Last Recertification Date
2/18/2025
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
7/14/2022
Contract Begin Date
10/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Matt Toburen, Executive Director
(612) 822-7946 Ext: 201
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
7/14/2022
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