Contract Pharmacy Details

PROCARE PHARMACY, L.L.C.
DSH350015 SANFORD BISMARCK

Covered Entity Details

Entity Name

SANFORD BISMARCK

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH350015

Entity Address

300 N 7TH ST
BISMARCK, ND 58501

Medicare Provider Number

350015

Participating Start Date

7/1/2016

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

4/23/2021

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Kirk Cristy, Vice President Finance
(701) 323-6000 Ext: 6310

Contract Pharmacy Representative

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

Signed By Date

4/15/2021

340B Drug Pricing Program Database