Contract Pharmacy Details

PROCARE PHARMACY, L.L.C.
RRC230130-00 WILLIAM BEAUMONT HOSPITAL dba Beaumont Hospital - Royal Oak

Covered Entity Details

Entity Name

WILLIAM BEAUMONT HOSPITAL dba Beaumont Hospital - Royal Oak

Subdivision Name

Type

Rural Referral Center

340B ID

RRC230130-00

Entity Address

3601 WEST 13 MILE ROAD
ROYAL OAK, MI 48073-6769

Medicare Provider Number

230130

Participating Start Date

4/1/2017

Last Recertification Date

8/30/2023

Entity Termination Date

4/1/2024

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

Contract Termination Date
Termination Reason

4/1/2024
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Carolyn Wilson, Chief Operating Officer
(947) 522-3338

Contract Pharmacy Representative

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

Signed By Date

7/12/2021

340B Drug Pricing Program Database