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PROCARE PHARMACY DIRECT, L.L.C.
DSH360048 UNIV OF TOLEDO MEDL CENTER
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Covered Entity Details
Entity Name
UNIV OF TOLEDO MEDL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH360048
Entity Address
3000 ARLINGTON AVENUE
TOLEDO, OH 43614-2589
Medicare Provider Number
360048
Participating Start Date
4/1/2016
Last Recertification Date
8/29/2024
Pharmacy Details
Pharmacy Name
PROCARE PHARMACY DIRECT, L.L.C.
Pharmacy Address
DBA CVS/SPECIALTY OR CARELONRX SPECIALTY
105 MALL BOULEVARD
MONROEVILLE, PA 15146
Pharmacy Comments
12/11/2009 - PHARMACY MOVED FROM 600 PENN CENTER BLVD., PITTSBURGH, PA 15235-5810 AND NAME CHANGE (WAS PROCARE PHARMACY DIRECT, INC DBA PHARMACARE SPECIALTY PHARMACY)
Contract Details
Approval Date
4/13/2020
Contract Begin Date
7/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Russell Wayne Smith, Senior Hospital Administrator
(419) 383-3788
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
4/13/2020
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