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PROCARE PHARMACY, L.L.C.
STD33193 MIRACLE COMMUNITY BEHAVIORAL CENTER CORP
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Covered Entity Details
Entity Name
MIRACLE COMMUNITY BEHAVIORAL CENTER CORP
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD33193
Entity Address
15660 SW 72 STREET
MIAMI, FL 33193
Grant Number
NH25P004342
Participating Start Date
1/1/2024
Last Recertification Date
5/6/2024
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
7/15/2024
Contract Begin Date
10/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
DELIA KENNEDY, COO
(786) 556-1397
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
7/15/2024
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