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PROCARE PHARMACY, L.L.C.
DSH220086 BETH ISRAEL DEACONESS MEDICAL CENTER
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Covered Entity Details
Entity Name
BETH ISRAEL DEACONESS MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH220086
Entity Address
330 Brookline Ave
BOSTON, MA 02215
Medicare Provider Number
220086
Participating Start Date
10/1/2009
Last Recertification Date
8/30/2024
Pharmacy Details
Pharmacy Name
PROCARE PHARMACY, L.L.C.
Pharmacy Address
DBA CVS/PHARMACY #2293
2 DUDLEY STREET SUITE 170
PROVIDENCE, RI 02905
Pharmacy Comments
Contract Details
Approval Date
7/16/2019
Contract Begin Date
10/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Michael Cullen, CFO
(617) 667-7146
Contract Pharmacy Representative
CVS
Christian Reid, 340B Program Director, CVS Pharmacy
(401) 770-2118
Signed By Date
7/16/2019
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