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PROCARE PHARMACY, L.L.C.
FQHCLA442 KWANG HE WON HEALTH CENTER
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Covered Entity Details
Entity Name
KWANG HE WON HEALTH CENTER
Subdivision Name
Kwang He Won Health Center
Type
Health Center Program Look-Alike
340B ID
FQHCLA442
Entity Address
815 S Ardmore Ave FL 1
Los Angeles, CA 90005-2597
Grant Number
LALCS47458
Participating Start Date
4/1/2023
Last Recertification Date
2/14/2025
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
4/11/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
BONGJA BENA WON, CEO
(213) 385-0448
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
4/11/2023
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