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PROCARE PHARMACY, L.L.C.
STD900333 The Wall Las Memorias
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Covered Entity Details
Entity Name
The Wall Las Memorias
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD900333
Entity Address
2020 E. 1st Street
Los Angeles, CA 90033
Grant Number
NU62PS924569
Participating Start Date
10/1/2024
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
4/2/2025
Contract Begin Date
7/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Richard Zaldivar, Executive Director
(323) 257-1056 Ext: 27
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
4/2/2025
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