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PROCARE PHARMACY DIRECT, L.L.C.
DSH330005 KALEIDA HEALTH
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Covered Entity Details
Entity Name
KALEIDA HEALTH
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH330005
Entity Address
100 High Street
BUFFALO, NY 14203
Medicare Provider Number
330005
Participating Start Date
4/1/2006
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
PROCARE PHARMACY DIRECT, L.L.C.
Pharmacy Address
DBA CVS/SPECIALTY OR CARELONRX SPECIALTY
105 MALL BOULEVARD
MONROEVILLE, PA 15146
Pharmacy Comments
12/11/2009 - PHARMACY MOVED FROM 600 PENN CENTER BLVD., PITTSBURGH, PA 15235-5810 AND NAME CHANGE (WAS PROCARE PHARMACY DIRECT, INC DBA PHARMACARE SPECIALTY PHARMACY)
Contract Details
Approval Date
7/15/2021
Contract Begin Date
10/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Paul E Belter, EVP Chief Financial Officer
(716) 859-8836
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
7/15/2021
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