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PROCARE PHARMACY, L.L.C.
DSH330104 MONTEFIORE NYACK HOSPITAL
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Covered Entity Details
Entity Name
MONTEFIORE NYACK HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH330104
Entity Address
160 NORTH MIDLAND AVENUE
NYACK, NY 10960
Medicare Provider Number
330104
Participating Start Date
4/1/2006
Last Recertification Date
8/16/2024
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
10/8/2020
Contract Begin Date
1/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
John S. Burke, CFO
(845) 348-2107
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
10/8/2020
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