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PROCARE PHARMACY, L.L.C.
RRC120026-00 PALI MOMI MEDICAL CENTER
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Covered Entity Details
Entity Name
PALI MOMI MEDICAL CENTER
Subdivision Name
Type
Rural Referral Center
340B ID
RRC120026-00
Entity Address
98-1079 MOANALUA ROAD
AIEA, HI 96701
Medicare Provider Number
120026
Participating Start Date
11/9/2020
Last Recertification Date
9/6/2024
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
11/9/2020
Contract Begin Date
11/9/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
MARTHA SMITH, Executive Vice President, Oahu Operations
(808) 522-2520
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
10/14/2020
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