340B Drug Pricing Program Database
PROCARE PHARMACY, L.L.C.
DSH220177 NANTUCKET COTTAGE HOSPITAL - information as of 5/21/2025 12:16:19 AM
Covered Entity Details
Entity Name
NANTUCKET COTTAGE HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH220177
Entity Address
57 PROSPECT STREET
NANTUCKET, MA 02554-2799
Medicare Provider Number
220177
Participating Start Date
3/15/2022
Last Recertification Date
9/8/2023
Entity Termination Date
4/1/2024
Pharmacy Details
Pharmacy Name
PROCARE PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY #2909
1521 4TH AVE., SOUTH
BIRMINGHAM, AL 35233
Pharmacy Comments
Contract Details
Approval Date
10/13/2022
Contract Begin Date
1/1/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2024
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Aaron S Fishman, VP, Finance
(508) 825-8205
Contract Pharmacy Representative
WELLPARTNER, A CVS HEALTH COMPANY
TOM ALBERTSON, NATIONAL SALES EXECUTIVE
(203) 343-3285
Signed By Date
10/13/2022
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