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PROCARE PHARMACY, L.L.C.
PED073300-00 CONNECTICUT CHILDREN'S MEDICAL CENTER
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Covered Entity Details
Entity Name
CONNECTICUT CHILDREN'S MEDICAL CENTER
Subdivision Name
Type
Children's Hospital
340B ID
PED073300-00
Entity Address
282 WASHINGTON STREET
HARTFORD, CT 06106
Medicare Provider Number
073300
Participating Start Date
7/1/2010
Last Recertification Date
8/26/2024
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
7/10/2020
Contract Begin Date
10/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Gil Peri, President & COO
(860) 885-8587
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
7/10/2020
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