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PROCARE PHARMACY, L.L.C.
CAH131312-00 ST. LUKE'S MCCALL, LTD
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Covered Entity Details
Entity Name
ST. LUKE'S MCCALL, LTD
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH131312-00
Entity Address
1000 State Street
MCCALL, ID 83638
Medicare Provider Number
131312
Participating Start Date
1/1/2013
Last Recertification Date
8/28/2024
Pharmacy Details
Pharmacy Name
PROCARE PHARMACY, L.L.C.
Pharmacy Address
DBA CVS/PHARMACY #2926
1001 MADISON ST.
SEATTLE, WA 98104
Pharmacy Comments
Contract Details
Approval Date
1/12/2021
Contract Begin Date
4/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Peter DiDio, Vice President, Controller
(208) 381-1251
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
1/12/2021
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