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PROCARE PHARMACY, L.L.C.
RRC500024-00 PROVIDENCE ST. PETER HOSPITAL
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Covered Entity Details
Entity Name
PROVIDENCE ST. PETER HOSPITAL
Subdivision Name
Type
Rural Referral Center
340B ID
RRC500024-00
Entity Address
413 LILLY ROAD NE
OLYMPIA, WA 98506
Medicare Provider Number
500024
Participating Start Date
4/1/2020
Last Recertification Date
9/11/2024
Pharmacy Details
Pharmacy Name
PROCARE PHARMACY, L.L.C.
Pharmacy Address
DBA CVS/PHARMACY #2926
1001 MADISON ST.
SEATTLE, WA 98104
Pharmacy Comments
Contract Details
Approval Date
10/15/2021
Contract Begin Date
1/1/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
3/6/2023
Agreement registered in error
Contacts
Covered Entity Signing Official
Denise Marroni, CFO SWR
(360) 493-5203
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
10/15/2021
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