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PROCARE PHARMACY, L.L.C.
STD704331 Baldone Reina Dermatology
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Covered Entity Details
Entity Name
Baldone Reina Dermatology
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD704331
Entity Address
150Lakeview Circle
Covington, LA 70433
Grant Number
NU62PS924522
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
4/9/2025
Contract Begin Date
7/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Stephanie C Moga, Office Manager
(985) 892-3376
Contract Pharmacy Representative
CVS Health
Christian Reid, 340B Program Director
(401) 770-2118
Signed By Date
4/9/2025
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