Contract Pharmacy Details

PROCARE PHARMACY, L.L.C.
DSH340047 NORTH CAROLINA BAPTIST HOSPITAL

Covered Entity Details

Entity Name

NORTH CAROLINA BAPTIST HOSPITAL

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH340047

Entity Address

MEDICAL CENTER BOULEVARD
WINSTON-SALEM, NC 27157

Medicare Provider Number

340047

Participating Start Date

4/1/1998

Last Recertification Date

8/23/2024

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

4/22/2019

Contract Begin Date

7/1/2019

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Conrad Emmerich, Sr. Vice President,Hospital & Business Services
(336) 716-8941

Contract Pharmacy Representative

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

Signed By Date

4/22/2019

340B Drug Pricing Program Database