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PROCARE PHARMACY, L.L.C.
CHC31892-06 CENTERPLACE HEALTH INC
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Covered Entity Details
Entity Name
CENTERPLACE HEALTH INC
Subdivision Name
North Port Behavioral Health Services Center
Type
HRSA-Funded Health Center
340B ID
CHC31892-06
Entity Address
6919 Outreach Way
North Port, FL 34287-3493
Grant Number
H80CS31892
Participating Start Date
10/1/2023
Last Recertification Date
2/10/2025
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
1/4/2024
Contract Begin Date
4/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Kari Aud Ellingstad, CEO
(941) 529-2422
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
1/4/2024
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