Contract Pharmacy Details

PROCARE PHARMACY, L.L.C.
RRC500072-00 OLYMPIC MEDICAL CENTER

Covered Entity Details

Entity Name

OLYMPIC MEDICAL CENTER

Subdivision Name

Type

Rural Referral Center

340B ID

RRC500072-00

Entity Address

939 CAROLINE STREET
PORT ANGELES, WA 98362

Medicare Provider Number

500072

Participating Start Date

10/1/2015

Last Recertification Date

9/3/2024

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

1/18/2021

Contract Begin Date

4/1/2021

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

8/9/2023
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Darryl Wolfe, Chief Executive Officer
(360) 417-7705

Contract Pharmacy Representative

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

Signed By Date

1/18/2021

340B Drug Pricing Program Database