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PROCARE PHARMACY, L.L.C.
CH057110 THIRD STREET COMMUNITY CLINIC
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Covered Entity Details
Entity Name
THIRD STREET COMMUNITY CLINIC
Subdivision Name
Third Street Community Clinic, Inc
Type
HRSA-Funded Health Center
340B ID
CH057110
Entity Address
600 W 3rd St
Mansfield, OH 44906-2633
Grant Number
H80CS00581
Participating Start Date
10/1/2001
Last Recertification Date
2/21/2025
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
4/12/2023
Contract Begin Date
4/12/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Peggy Anderson, CEO
(419) 526-7880
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
4/12/2023
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