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PROCARE PHARMACY, L.L.C.
CAH321305-00 NOR-LEA GENERAL HOSPITAL
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Covered Entity Details
Entity Name
NOR-LEA GENERAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH321305-00
Entity Address
1600 N. MAIN AVE
LOVINGTON, NM 88260
Medicare Provider Number
321305
Participating Start Date
9/24/2010
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
PROCARE PHARMACY, L.L.C.
Pharmacy Address
DBA CVS/PHARMACY #2751
426 S. HENDERSON STREET
FORT WORTH, TX 76104
Pharmacy Comments
Contract Details
Approval Date
10/14/2021
Contract Begin Date
1/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
ALLYSON ROBERTS, CFO
(575) 396-6611 Ext: 1126
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
10/14/2021
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