Contract Pharmacy Details

PROCARE PHARMACY, L.L.C.
RRC330119-00 LENOX HILL HOSPITAL

Covered Entity Details

Entity Name

LENOX HILL HOSPITAL

Subdivision Name

Type

Rural Referral Center

340B ID

RRC330119-00

Entity Address

100 EAST 77TH STREET
NEW YORK, NY 10075

Medicare Provider Number

330119

Participating Start Date

7/1/2017

Last Recertification Date

9/15/2021

Entity Termination Date

1/24/2022

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

10/16/2020

Contract Begin Date

1/1/2021

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

1/24/2022
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Michele L Cusack, Executive Vice President
(516) 321-6058

Contract Pharmacy Representative

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

Signed By Date

10/16/2020

340B Drug Pricing Program Database