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PROCARE PHARMACY, L.L.C.
DSH330180 SAMARITAN HOSPITAL
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Covered Entity Details
Entity Name
SAMARITAN HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH330180
Entity Address
2215 BURDETT AVE
TROY, NY 12180
Medicare Provider Number
330180
Participating Start Date
1/1/2019
Last Recertification Date
8/27/2024
Pharmacy Details
Pharmacy Name
PROCARE PHARMACY, L.L.C.
Pharmacy Address
DBA CVS/PHARMACY OR CARELONRX SPECIALTY
ONE WATERFRONT PLAZA
500 ALA MOANA BLVD., BLDG 1
HONOLULU, HI 96813
Pharmacy Comments
3/22/10 NAME CORRECTION (WAS CVS PROCARE PHARMACY DBA CVS PROCARE PHARMACY #2915) 3/17/10 ADDR CHANGE (WAS 970 N KALAHEO AVE, SUITE A 203)
Contract Details
Approval Date
7/12/2021
Contract Begin Date
10/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Lori Santos, CFO
(518) 525-5537
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
7/12/2021
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