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PROCARE PHARMACY, L.L.C.
DSH090004 Georgetown University Hospital
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Covered Entity Details
Entity Name
Georgetown University Hospital
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH090004
Entity Address
3800 Reservoir Road, NW
Washington, DC 20007
Medicare Provider Number
090004
Participating Start Date
4/1/2014
Last Recertification Date
8/15/2024
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
4/15/2021
Contract Begin Date
7/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
3/27/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
David C Ho, VP of Finance
(202) 444-4724
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
4/15/2021
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