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PROCARE PHARMACY, L.L.C.
DSH490009 UNIVERSITY OF VIRGINIA MEDICAL CENTER
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Covered Entity Details
Entity Name
UNIVERSITY OF VIRGINIA MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH490009
Entity Address
1215 Lee Street
RECVG LANE RD-LOADING DOCK
CHARLOTTESVILLE, VA 22908
Medicare Provider Number
490009
Participating Start Date
7/1/1993
Last Recertification Date
8/12/2024
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
4/26/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
2/4/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Brian Wilmoth, Strategic Planning and Reimbursement Officer
(434) 243-9802
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
4/15/2021
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