Contract Pharmacy Details

PROCARE PHARMACY, L.L.C.
DSH330231 QUEENS HOSPITAL CENTER (NYCHHC)

Covered Entity Details

Entity Name

QUEENS HOSPITAL CENTER (NYCHHC)

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH330231

Entity Address

82-68 164TH ST.
JAMAICA, NY 11432

Medicare Provider Number

330231

Participating Start Date

12/1/1992

Last Recertification Date

9/4/2024

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

4/10/2019

Contract Begin Date

7/1/2019

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Paul Albertson, Vice President
(212) 748-2256

Contract Pharmacy Representative

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

Signed By Date

4/10/2019

340B Drug Pricing Program Database