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PROCARE PHARMACY DIRECT, L.L.C.
CHC26564-03 SOUTH CENTRAL MISSOURI COMMUNITY HEALTH CENTER
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Covered Entity Details
Entity Name
SOUTH CENTRAL MISSOURI COMMUNITY HEALTH CENTER
Subdivision Name
Four Rivers Community Health Center
Type
HRSA-Funded Health Center
340B ID
CHC26564-03
Entity Address
1081 E 18th St
Rolla, MO 65401
Grant Number
H80CS26564
Participating Start Date
1/1/2017
Last Recertification Date
2/21/2025
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
4/14/2020
Contract Begin Date
7/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Stuart Gipson, CEO
(573) 426-6714
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
4/14/2020
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