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PROCARE PHARMACY, L.L.C.
CH067230 HIDALGO MEDICAL SERVICES, INC
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Covered Entity Details
Entity Name
HIDALGO MEDICAL SERVICES, INC
Subdivision Name
HIDALGO MEDICAL SERVICES
Type
HRSA-Funded Health Center
340B ID
CH067230
Entity Address
530 De Moss St
Lordsburg, NM 88045-2618
Grant Number
H80CS00744
Participating Start Date
10/1/2001
Last Recertification Date
2/10/2025
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
10/16/2022
Contract Begin Date
1/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Daniel Otero, CEO
(575) 590-7090
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
10/16/2022
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