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PROCARE PHARMACY, L.L.C.
DSH500027 SWEDISH MEDICAL CENTER
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Covered Entity Details
Entity Name
SWEDISH MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH500027
Entity Address
747 BROADWAY
SEATTLE, WA 98122
Medicare Provider Number
500027
Participating Start Date
7/1/2006
Last Recertification Date
9/9/2024
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
7/26/2021
Contract Begin Date
10/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Marybeth Formby, Chief Financial Officer
(206) 386-3033
Contract Pharmacy Representative
CVS Pharmacies
Christian Reid, 340B Program Director
(401) 770-2118
Signed By Date
7/26/2021
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