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PROCARE PHARMACY, L.L.C.
DSH060054 COMMUNITY HOSPITAL
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Covered Entity Details
Entity Name
COMMUNITY HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH060054
Entity Address
2351 G ROAD
GRAND JUNCTION, CO 81505
Medicare Provider Number
060054
Participating Start Date
4/1/2021
Last Recertification Date
8/23/2024
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
7/19/2021
Contract Begin Date
7/29/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Christian A. Thomas, CEO
(970) 644-3011
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
7/19/2021
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