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PROCARE PHARMACY, L.L.C.
DSH510012 PLEASANT VALLEY HOSPITAL
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Covered Entity Details
Entity Name
PLEASANT VALLEY HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH510012
Entity Address
2520 VALLEY DRIVE
POINT PLEASANT, WV 25550
Medicare Provider Number
510012
Participating Start Date
7/1/2006
Last Recertification Date
8/14/2024
Entity Termination Date
4/1/2025
Pharmacy Details
Pharmacy Name
PROCARE PHARMACY, L.L.C.
Pharmacy Address
DBA CVS/PHARMACY #2923
3250 HARDEN ST. EXT. SUITE #300
COLUMBIA, SC 29203
Pharmacy Comments
Contract Details
Approval Date
7/8/2020
Contract Begin Date
10/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
5/10/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Craig Gilliland, Chief Financial Officer
(304) 675-4340 Ext: 1398
Contract Pharmacy Representative
Pleasant Valley Hospital
John Beaver, Pharmacy Director
(304) 675-4340 Ext: 1160
Signed By Date
7/8/2020
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