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PROCARE PHARMACY, L.L.C.
RRC330140-00 ST. JOSEPHS HOSPITAL HEALTH CENTER
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Covered Entity Details
Entity Name
ST. JOSEPHS HOSPITAL HEALTH CENTER
Subdivision Name
Type
Rural Referral Center
340B ID
RRC330140-00
Entity Address
301 PROSPECT AVENUE
SYRACUSE, NY 13203
Medicare Provider Number
330140
Participating Start Date
10/1/2021
Last Recertification Date
8/26/2024
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
10/21/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Meredith Anne Price, Chief Financial Officer
(315) 448-5888
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
10/15/2021
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