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PROCARE PHARMACY, L.L.C.
STD85345 Your Health and Wellness PLLC
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Covered Entity Details
Entity Name
Your Health and Wellness PLLC
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD85345
Entity Address
8466 W Peoria Avenue
Suite 9
Peoria, AZ 85345
Grant Number
NU62PS924550
Participating Start Date
7/1/2024
Last Recertification Date
Entity Termination Date
1/1/2025
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
5/15/2024
Contract Begin Date
7/1/2024
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2025
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Mark Knoblauch, Owner
(602) 625-7944
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
4/7/2024
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