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PROCARE PHARMACY, L.L.C.
DSH500014 PROVIDENCE HEALTH & SERVICES - WASHINGTON
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Covered Entity Details
Entity Name
PROVIDENCE HEALTH & SERVICES - WASHINGTON
Subdivision Name
PROVIDENCE REGIONAL MEDICAL CENTER EVERETT COLBY CAMPUS
Type
Disproportionate Share Hospital
340B ID
DSH500014
Entity Address
1321 COLBY AVENUE
EVERETT, WA 98201
Medicare Provider Number
500014
Participating Start Date
4/1/2005
Last Recertification Date
9/4/2024
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
10/15/2019
Contract Begin Date
1/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Scott Combs, CFO
(425) 261-4044
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
10/15/2019
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