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PROCARE PHARMACY, L.L.C.
DSH060001 Banner North Colorado Medical Center
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Covered Entity Details
Entity Name
Banner North Colorado Medical Center
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH060001
Entity Address
1801 16th Street
Greeley, CO 80631
Medicare Provider Number
060001
Participating Start Date
10/1/2013
Last Recertification Date
9/3/2024
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
7/14/2020
Contract Begin Date
10/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Matthew P Huff, CFO
(480) 543-2277
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
7/14/2020
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