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PROCARE PHARMACY, L.L.C.
STD39216 My Brother's Keeper, Inc.
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Covered Entity Details
Entity Name
My Brother's Keeper, Inc.
Subdivision Name
Open Arms Healthcare Center
Type
Sexually Transmitted Diseases
340B ID
STD39216
Entity Address
805 E. River Place
Jackson, MS 39206
Grant Number
NU65PS923762
Participating Start Date
4/1/2014
Last Recertification Date
5/28/2024
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
10/8/2024
Contract Begin Date
1/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
June Gipson, CEO
(769) 216-2455
Contract Pharmacy Representative
CVSHEALTH
ADAM J HORN, ACCOUNT MGR
(773) 610-9315
Signed By Date
10/8/2024
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