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PROCARE PHARMACY, L.L.C.
DSH420055 MUSC HEALTH MARION MEDICAL CENTER
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Covered Entity Details
Entity Name
MUSC HEALTH MARION MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH420055
Entity Address
2829 EAST HWY 76
MULLINS, SC 29574
Medicare Provider Number
420055
Participating Start Date
7/1/2020
Last Recertification Date
8/19/2024
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
Lisa Goodlett, Chief Financial Officer
(843) 792-4775
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
10/15/2020
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