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PROCARE PHARMACY, L.L.C.
STD704333 Mary Bird Perkins Cancer Center
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Covered Entity Details
Entity Name
Mary Bird Perkins Cancer Center
Subdivision Name
Mary Bird Perkins Cancer Center
Type
Sexually Transmitted Diseases
340B ID
STD704333
Entity Address
1203 S. Tyler St
Covington, LA 70433
Grant Number
NH25PS005176
Participating Start Date
4/1/2025
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
4/1/2025
Contract Begin Date
7/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jodi Conachen, COO
(225) 215-1210
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
4/1/2025
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