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PROCARE PHARMACY, L.L.C.
CAH111328-00 Phoebe Worth Medical Center
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Covered Entity Details
Entity Name
Phoebe Worth Medical Center
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH111328-00
Entity Address
807 South Isabella Street
Sylvester, GA 31791-0545
Medicare Provider Number
111328
Participating Start Date
10/1/2011
Last Recertification Date
8/27/2024
Pharmacy Details
Pharmacy Name
PROCARE PHARMACY, L.L.C.
Pharmacy Address
CVS/PHARMACY #48637
2700 NORTHEAST EXPY NE STE B800
BUILDING B
ATLANTA, GA 30345
Pharmacy Comments
Contract Details
Approval Date
7/20/2020
Contract Begin Date
10/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Candace Guarnieri, VP of Finance
(229) 777-3851
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
7/20/2020
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