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PROCARE PHARMACY, L.L.C.
DSH470005 RUTLAND REGIONAL MEDICAL CENTER
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Covered Entity Details
Entity Name
RUTLAND REGIONAL MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH470005
Entity Address
160 ALLEN STREET
RUTLAND, VT 05701
Medicare Provider Number
470005
Participating Start Date
7/1/2016
Last Recertification Date
8/30/2024
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
7/20/2020
Contract Begin Date
10/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Judi K Fox, CFO
(802) 747-1632
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
7/20/2020
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