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PROCARE PHARMACY, L.L.C.
CAH301307-00 MaineHealth Memorial Hospital
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Covered Entity Details
Entity Name
MaineHealth Memorial Hospital
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH301307-00
Entity Address
3073 White Mountain Hwy
North Conway, NH 03860-7101
Medicare Provider Number
301307
Participating Start Date
10/1/2011
Last Recertification Date
8/23/2024
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
Diana J. McLaughlin, Chief Financial Officer
(603) 356-0613 Ext: 2537
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
10/15/2020
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