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PROCARE PHARMACY, L.L.C.
DSH440015 UNIVERSITY OF TENNESSEE MEDICAL CENTER
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Covered Entity Details
Entity Name
UNIVERSITY OF TENNESSEE MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH440015
Entity Address
1924 ALCOA HWY
KNOXVILLE, TN 37920
Medicare Provider Number
440015
Participating Start Date
7/1/2001
Last Recertification Date
9/4/2024
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
7/14/2021
Contract Begin Date
10/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/15/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Steven Robert Ross, Senior Vice President, Strategic Development
(865) 305-6400
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
7/14/2021
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