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PROCARE PHARMACY, L.L.C.
DSH050360 MARIN GENERAL HOSPITAL
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Covered Entity Details
Entity Name
MARIN GENERAL HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH050360
Entity Address
250 BON AIR ROAD
GREENBRAE, CA 94904
Medicare Provider Number
050360
Participating Start Date
7/1/2016
Last Recertification Date
9/10/2024
Pharmacy Details
Pharmacy Name
PROCARE PHARMACY, L.L.C.
Pharmacy Address
DBA CVS/PHARMACY
445 CASTRO STREET
SAN FRANCISCO, CA 94114
Pharmacy Comments
Contract Details
Approval Date
1/15/2020
Contract Begin Date
4/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/14/2024
Pharmacy closed
Contacts
Covered Entity Signing Official
Elizabeth Lasnier, Controller
(415) 925-7449
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
1/15/2020
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