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PROCARE PHARMACY, L.L.C.
DSH160083 CATHOLIC HEALTH INITIATIVES - IOWA, CORP
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Covered Entity Details
Entity Name
CATHOLIC HEALTH INITIATIVES - IOWA, CORP
Subdivision Name
MERCYONE DES MOINES MEDICAL CENTER
Type
Disproportionate Share Hospital
340B ID
DSH160083
Entity Address
1111 6th Avenue
DES MOINES, IA 50314-2610
Medicare Provider Number
160083
Participating Start Date
4/1/2011
Last Recertification Date
9/4/2024
Pharmacy Details
Pharmacy Name
PROCARE PHARMACY, L.L.C.
Pharmacy Address
DBA CVS/PHARMACY OR CARELONRX SPECIALTY
ONE WATERFRONT PLAZA
500 ALA MOANA BLVD., BLDG 1
HONOLULU, HI 96813
Pharmacy Comments
3/22/10 NAME CORRECTION (WAS CVS PROCARE PHARMACY DBA CVS PROCARE PHARMACY #2915) 3/17/10 ADDR CHANGE (WAS 970 N KALAHEO AVE, SUITE A 203)
Contract Details
Approval Date
7/10/2020
Contract Begin Date
10/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Randall Rubin, Senior Vice President Chief Financial Officer
(515) 643-2860
Contract Pharmacy Representative
Catholic Health Initiatives, Iowa Corp
Candace Marie Jordan, Mkt Director of Pharmacy
(515) 247-3262
Signed By Date
7/10/2020
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