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PROCARE PHARMACY, L.L.C.
RRC360147-00 MARIETTA MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
MARIETTA MEMORIAL HOSPITAL
Subdivision Name
Type
Rural Referral Center
340B ID
RRC360147-00
Entity Address
401 MATTHEW STREET
MARIETTA, OH 45750
Medicare Provider Number
360147
Participating Start Date
1/1/2015
Last Recertification Date
8/21/2024
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
7/12/2021
Contract Begin Date
10/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Doug Full, Director of Finance
(740) 374-1698
Contract Pharmacy Representative
CVS
Christian Reid, 340B Program Director, CVS Pharmacy
(401) 770-2118
Signed By Date
7/12/2021
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