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PROCARE PHARMACY, L.L.C.
STD85028 RSG Healthcare
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Covered Entity Details
Entity Name
RSG Healthcare
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD85028
Entity Address
11209 N Tatum BLVD
STE 185
Phoenix, AZ 85028
Grant Number
NU62PS924550
Participating Start Date
7/1/2024
Last Recertification Date
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
6/5/2024
Contract Begin Date
7/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Randy S Gelow, Owner/Medical Doctor
(602) 669-2585
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
4/9/2024
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