Contract Pharmacy Details

PROCARE PHARMACY, L.L.C.
DSH320021 PRESBYTERIAN HOSPITAL

Covered Entity Details

Entity Name

PRESBYTERIAN HOSPITAL

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH320021

Entity Address

1100 CENTRAL AVENUE SE
ALBUQUERQUE, NM 87106

Medicare Provider Number

320021

Participating Start Date

4/1/2005

Last Recertification Date

9/6/2024

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

4/14/2021

Contract Begin Date

7/1/2021

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

David Scott Graham, VP-PDS Clinical Support Srvc
(505) 841-1872

Contract Pharmacy Representative

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

Signed By Date

4/14/2021

340B Drug Pricing Program Database