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PROCARE PHARMACY, L.L.C.
DSH220119 Brigham and Women's Faulkner Hospital
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Covered Entity Details
Entity Name
Brigham and Women's Faulkner Hospital
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH220119
Entity Address
1153 CENTRE STREET
Boston, MA 02130
Medicare Provider Number
220119
Participating Start Date
7/1/2017
Last Recertification Date
9/5/2024
Pharmacy Details
Pharmacy Name
PROCARE PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY #2971
350 LONGWOOD AVE., STE B
BOSTON, MA 02115
Pharmacy Comments
Contract Details
Approval Date
10/12/2021
Contract Begin Date
1/1/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/22/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Gerard F. Hadley, Vice President for Finance
(617) 983-7159
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
10/12/2021
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