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PROCARE PHARMACY, L.L.C.
DSH210062 MEDSTAR SOUTHERN MARYLAND HOSPITAL C
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Covered Entity Details
Entity Name
MEDSTAR SOUTHERN MARYLAND HOSPITAL C
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH210062
Entity Address
7503 SURRATTS ROAD
CLINTON, MD 20735
Medicare Provider Number
210062
Participating Start Date
10/1/2015
Last Recertification Date
8/21/2024
Pharmacy Details
Pharmacy Name
PROCARE PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY #2909
1521 4TH AVE., SOUTH
BIRMINGHAM, AL 35233
Pharmacy Comments
Contract Details
Approval Date
4/14/2021
Contract Begin Date
7/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/8/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Michael J Meisel, VP Finance and Chief Financial Officer
(202) 503-8720
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
4/14/2021
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