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PROCARE PHARMACY, L.L.C.
STD85029 TL Family Nurse Practice LLC
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Covered Entity Details
Entity Name
TL Family Nurse Practice LLC
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD85029
Entity Address
3201 W Peoria Ave
A105
Phoenix, AZ 85029
Grant Number
NU51PS005142
Participating Start Date
4/1/2023
Last Recertification Date
5/7/2024
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
4/3/2023
Contract Begin Date
5/3/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Tara Begay, FNP/ Co Owner
(602) 918-3225
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
4/3/2023
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