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PROCARE PHARMACY, L.L.C.
STD704332 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
STD704332
Entity Address
7015 Hwy 190E. Service Rd
Suite 102
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
4/11/2025
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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