Contract Pharmacy Details

PROCARE PHARMACY, L.L.C.
STD337071 Empath Health, Inc.

Covered Entity Details

Entity Name

Empath Health, Inc.

Subdivision Name

AIDS Service Association of Pinellas, Inc. dba EPIC

Type

Sexually Transmitted Diseases

340B ID

STD337071

Entity Address

300 49th Street S
St.Petersburg, FL 33707

Grant Number

1NU62PS924687-1-00

Participating Start Date

4/1/2021

Last Recertification Date

5/9/2024

Entity Termination Date

7/1/2024

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

10/31/2023

Contract Begin Date

1/1/2024

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

7/1/2024
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Saida Bouhamid, Chief Mission Financial Officer
(727) 523-3339

Contract Pharmacy Representative

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

Signed By Date

10/31/2023

340B Drug Pricing Program Database