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PROCARE PHARMACY, L.L.C.
CH100180 HEALTH WEST INC
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Covered Entity Details
Entity Name
HEALTH WEST INC
Subdivision Name
HEALTH WEST - ADMINISTRATION OFFICES
Type
HRSA-Funded Health Center
340B ID
CH100180
Entity Address
500 S 11th AVE
POCATELLO, ID 83201-4835
Grant Number
H80CS00321
Participating Start Date
4/1/2004
Last Recertification Date
2/12/2025
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
7/1/2024
Contract Begin Date
10/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Mark T Horrocks, Chief Medical Officer
(208) 232-7862
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
7/1/2024
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