Contract Pharmacy Details

PROCARE PHARMACY, L.L.C.
DSH370004 INTEGRIS MIAMI HOSPITAL

Covered Entity Details

Entity Name

INTEGRIS MIAMI HOSPITAL

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH370004

Entity Address

200 2ND AVE. SW
MIAMI, OK 74354

Medicare Provider Number

370004

Participating Start Date

1/1/2023

Last Recertification Date

8/22/2024

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

10/14/2020

Contract Begin Date

1/1/2021

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

2/7/2022
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Chris Hammes, Executive Vice President
(405) 949-3400

Contract Pharmacy Representative

CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782

Signed By Date

10/14/2020

340B Drug Pricing Program Database