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PROCARE PHARMACY, L.L.C.
PED393303-00 THE CHILDREN'S HOSPITAL OF PHILADELPHIA
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Covered Entity Details
Entity Name
THE CHILDREN'S HOSPITAL OF PHILADELPHIA
Subdivision Name
Type
Children's Hospital
340B ID
PED393303-00
Entity Address
3401 Civic Center Blvd
PHILADELPHIA, PA 19104
Medicare Provider Number
393303
Participating Start Date
1/1/2010
Last Recertification Date
8/28/2024
Pharmacy Details
Pharmacy Name
PROCARE PHARMACY, L.L.C.
Pharmacy Address
DBA CVS/PHARMACY # 02553
1117 WALNUT ST.
PHILADELPHIA, PA 19107
Pharmacy Comments
Contract Details
Approval Date
4/15/2020
Contract Begin Date
7/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
THOMAS J. TODOROW, EXECUTIVE VICE PRESIDENT FINANCE AND CHIEF FINANCIAL OFFICER
(267) 426-6957
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
4/15/2020
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