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PROCARE PHARMACY, L.L.C.
STD330302 Mani Medical Center
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Covered Entity Details
Entity Name
Mani Medical Center
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD330302
Entity Address
151 NW 11th Street
W303
Homestead, FL 33030
Grant Number
NH25PS005131
Participating Start Date
12/7/2021
Last Recertification Date
5/9/2024
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
10/2/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Steve Taylor, CEO/Present
(954) 854-7475
Contract Pharmacy Representative
wellpartner
Crissy Levisay, Account Manager
(239) 322-4188
Signed By Date
10/2/2023
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