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PROCARE PHARMACY, L.L.C.
STD704033 Northlake Gastroenterology Associates, LLP
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Covered Entity Details
Entity Name
Northlake Gastroenterology Associates, LLP
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD704033
Entity Address
16061 Doctors Blvd.
Suite B
Hammond, LA 70403
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
4/11/2025
Contract Begin Date
7/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Martin Leahy, Manager
(985) 542-1334
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
4/11/2025
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