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PROCARE PHARMACY, L.L.C.
FP191071 MAZZONI CENTER
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Covered Entity Details
Entity Name
MAZZONI CENTER
Subdivision Name
Type
Family Planning (Title X only)
340B ID
FP191071
Entity Address
1348 BAINBRIDGE STREET
PHILADELPHIA, PA 19147
Grant Number
FPHPA006433
Participating Start Date
4/1/2003
Last Recertification Date
5/17/2023
Entity Termination Date
7/1/2024
Pharmacy Details
Pharmacy Name
PROCARE PHARMACY, L.L.C.
Pharmacy Address
DBA CVS/PHARMACY # 02553
1117 WALNUT ST.
PHILADELPHIA, PA 19107
Pharmacy Comments
Contract Details
Approval Date
1/9/2018
Contract Begin Date
4/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
3/16/2020
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Ronald Powers, COO
(215) 563-0652 Ext: 210
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
1/9/2018
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