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PROCARE PHARMACY, L.L.C.
DSH490037 RIVERSIDE SHORE MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
RIVERSIDE SHORE MEMORIAL HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH490037
Entity Address
20480 Market Street
Onancock, VA 23417
Medicare Provider Number
490037
Participating Start Date
7/1/2004
Last Recertification Date
8/14/2024
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
7/15/2021
Contract Begin Date
10/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
WILLIAM W. AUSTIN JR., SENIOR VP & CFO
(757) 534-7015
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
7/15/2021
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