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PROCARE PHARMACY, L.L.C.
DSH330084 ALICE HYDE MEDICAL CENTER
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Covered Entity Details
Entity Name
ALICE HYDE MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH330084
Entity Address
133 PARK STREET
MALONE, NY 12953-0729
Medicare Provider Number
330084
Participating Start Date
10/1/2011
Last Recertification Date
8/29/2023
Entity Termination Date
11/27/2023
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
7/14/2020
Contract Begin Date
7/20/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
11/27/2023
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Christopher Hickey, Sr. Vice President/Chief Financial Officer
(518) 481-8067
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
7/14/2020
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