Contract Pharmacy Details

PROCARE PHARMACY, L.L.C.
RWI10035 Bailey House

Covered Entity Details

Entity Name

Bailey House

Subdivision Name

Type

Ryan White Part A

340B ID

RWI10035

Entity Address

1751 Park Avenue
New York, NY 10035

Grant Number

H89HA00015

Participating Start Date

10/1/2014

Last Recertification Date

2/6/2019

Entity Termination Date

4/1/2020

Pharmacy Details

Pharmacy Name

PROCARE PHARMACY, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 2919
126 EIGHTH AVE.
NEW YORK, NY 10011

Pharmacy Comments

Contract Details

Approval Date

10/3/2018

Contract Begin Date

1/1/2019

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

4/1/2020
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Lauren Estby, Vice President of Integrated Health and Operations
(212) 633-2500 Ext: 332

Contract Pharmacy Representative

CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782

Signed By Date

10/3/2018

340B Drug Pricing Program Database