Contract Pharmacy Details

PROCARE PHARMACY, L.L.C.
RRC100292-00 SACRED HEART HOSPITAL ON THE EMERALD

Covered Entity Details

Entity Name

SACRED HEART HOSPITAL ON THE EMERALD

Subdivision Name

Type

Rural Referral Center

340B ID

RRC100292-00

Entity Address

7800 US HIGHWAY 98 WEST
DESTIN, FL 32550

Medicare Provider Number

100292

Participating Start Date

1/1/2021

Last Recertification Date

8/20/2024

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

7/20/2021

Contract Begin Date

10/1/2021

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

11/22/2024
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Susan Cornejo, Chief Operating Officer
(850) 416-6206

Contract Pharmacy Representative

Caremark L.L.C.
Christian reid, 340b Program Director
(401) 770-2118

Signed By Date

7/20/2021

340B Drug Pricing Program Database