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PROCARE PHARMACY, L.L.C.
RRC070024-00 THE WILLIAM W. BACKUS HOSPITAL
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Covered Entity Details
Entity Name
THE WILLIAM W. BACKUS HOSPITAL
Subdivision Name
Type
Rural Referral Center
340B ID
RRC070024-00
Entity Address
326 WASHINGTON STREET
NORWICH, CT 06360
Medicare Provider Number
070024
Participating Start Date
4/1/2025
Last Recertification Date
Entity Termination Date
4/1/2025
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
4/16/2021
Contract Begin Date
7/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
3/13/2023
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Anthony Mastroianni, Regional Vice President, Finance
(860) 889-8331 Ext: 2311
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
4/16/2021
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