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PROCARE PHARMACY, L.L.C.
DSH180020 MIDDLESBORO ARH HOSPITAL
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Covered Entity Details
Entity Name
MIDDLESBORO ARH HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH180020
Entity Address
3600 WEST CUMBERLAND AVE
MIDDLESBORO, KY 40965
Medicare Provider Number
180020
Participating Start Date
4/1/2005
Last Recertification Date
9/3/2024
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
7/8/2021
Contract Begin Date
10/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Hollie P Harris, President & CEO
(859) 226-2511
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
7/8/2021
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