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PROCARE PHARMACY, L.L.C.
CH063920 LA FAMILIA MEDICAL CENTER INC
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Covered Entity Details
Entity Name
LA FAMILIA MEDICAL CENTER INC
Subdivision Name
La Famila Medical Center Dental Clinic
Type
HRSA-Funded Health Center
340B ID
CH063920
Entity Address
6401 S Richards Ave
Santa Fe, NM 87508-4887
Grant Number
H80CS00606
Participating Start Date
12/1/1992
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
7/11/2024
Contract Begin Date
10/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Brandon Vanessa Van Pelt, Interim CEO
(505) 982-4425 Ext: 1067
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
7/11/2024
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