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PROCARE PHARMACY, L.L.C.
CH0933070 ST. VINCENT DE PAUL VILLAGE, INC.
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Covered Entity Details
Entity Name
ST. VINCENT DE PAUL VILLAGE, INC.
Subdivision Name
Village Health Center
Type
HRSA-Funded Health Center
340B ID
CH0933070
Entity Address
16 15th St
San Diego, CA 92101
Grant Number
H80CS10606
Participating Start Date
9/5/2008
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
4/6/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jeffrey Norris, CMO
(619) 645-6422
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
4/6/2023
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