Contract Pharmacy Details

PROCARE PHARMACY, L.L.C.
CHC26633-00 Owensville Primary Care, Inc.

Covered Entity Details

Entity Name

Owensville Primary Care, Inc.

Subdivision Name

OPC Shady Side V1

Type

HRSA-Funded Health Center

340B ID

CHC26633-00

Entity Address

6131 Shady Side Rd
Shady Side, MD 20764-9504

Grant Number

H80CS26633

Participating Start Date

10/1/2022

Last Recertification Date

3/5/2025

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

7/5/2023

Contract Begin Date

10/1/2023

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Juanita M Tryon, Chief Executive Officer
(443) 607-1438

Contract Pharmacy Representative

CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782

Signed By Date

7/5/2023

340B Drug Pricing Program Database