Contract Pharmacy Details

PROCARE PHARMACY, L.L.C.
RWI19147 Mazzoni Center

Covered Entity Details

Entity Name

Mazzoni Center

Subdivision Name

Type

Ryan White Part A

340B ID

RWI19147

Entity Address

1348 Bainbridge Street
Philadelphia, PA 19147-1810

Grant Number

H89HA00013

Participating Start Date

4/1/2018

Last Recertification Date

2/17/2025

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

10/16/2023

Contract Begin Date

1/1/2024

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Alecia Manley, Executive Operating Officer
(215) 563-0652

Contract Pharmacy Representative

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

Signed By Date

10/16/2023

340B Drug Pricing Program Database