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PROCARE PHARMACY, L.L.C.
CHC25680-18 PORTLAND COMMUNITY HEALTH CENTER
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Covered Entity Details
Entity Name
PORTLAND COMMUNITY HEALTH CENTER
Subdivision Name
Greater Portland Health at 654 Riverside Street
Type
HRSA-Funded Health Center
340B ID
CHC25680-18
Entity Address
654 Riverside St
Portland, ME 04103-1086
Grant Number
H80CS25680
Participating Start Date
1/1/2024
Last Recertification Date
3/3/2025
Pharmacy Details
Pharmacy Name
PROCARE PHARMACY, L.L.C.
Pharmacy Address
DBA CVS/PHARMACY OR CARELONRX SPECIALTY
ONE WATERFRONT PLAZA
500 ALA MOANA BLVD., BLDG 1
HONOLULU, HI 96813
Pharmacy Comments
3/22/10 NAME CORRECTION (WAS CVS PROCARE PHARMACY DBA CVS PROCARE PHARMACY #2915) 3/17/10 ADDR CHANGE (WAS 970 N KALAHEO AVE, SUITE A 203)
Contract Details
Approval Date
10/13/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Ann Tucker, Chief Executive Officer
(207) 874-2141 Ext: 3886
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
10/13/2023
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