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PROCARE PHARMACY, L.L.C.
CAH261306-00 SULLIVAN COUNTY MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
SULLIVAN COUNTY MEMORIAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH261306-00
Entity Address
630 WEST THIRD STREET
MILAN, MO 63556
Medicare Provider Number
261306
Participating Start Date
10/1/2015
Last Recertification Date
8/27/2024
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
10/15/2020
Contract Begin Date
1/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Tony Keene, CEO
(660) 265-4212 Ext: 610
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
10/15/2020
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