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PROCARE PHARMACY, L.L.C.
DSH500054 PROVIDENCE HEALTH & SERVICES - WASHINGTON
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Covered Entity Details
Entity Name
PROVIDENCE HEALTH & SERVICES - WASHINGTON
Subdivision Name
PROVIDENCE SACRED HEART MEDICAL CENTER AND CHILDREN'S HOSPITAL
Type
Disproportionate Share Hospital
340B ID
DSH500054
Entity Address
101 WEST 8TH AVENUE
SPOKANE, WA 99204
Medicare Provider Number
500054
Participating Start Date
1/1/2005
Last Recertification Date
9/4/2024
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
4/12/2021
Contract Begin Date
7/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
6/10/2021
Agreement registered in error
Contacts
Covered Entity Signing Official
Shelby D Stokoe, CFO Providence Health Care
(509) 474-4949
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
4/12/2021
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