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PROCARE PHARMACY, L.L.C.
DSH060028 Saint Joseph Hospital, Inc. DBA Intermountain Health Saint Joseph Hospital
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Covered Entity Details
Entity Name
Saint Joseph Hospital, Inc. DBA Intermountain Health Saint Joseph Hospital
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH060028
Entity Address
1375 EAST 19TH AVENUE
DENVER, CO 80218
Medicare Provider Number
060028
Participating Start Date
7/1/2016
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
10/15/2021
Contract Begin Date
1/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Brad Membel, VP Finance, CFO
(303) 812-4936
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
10/15/2021
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