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PROCARE PHARMACY, L.L.C.
CAH241379-00 Prairie Ridge Hospital and Health Services
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Covered Entity Details
Entity Name
Prairie Ridge Hospital and Health Services
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH241379-00
Entity Address
1411 Hwy 79 East
Elbow Lake, MN 56531
Medicare Provider Number
241379
Participating Start Date
1/1/2014
Last Recertification Date
9/4/2024
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
Danielle Janice Lesmeister, Chief Executive Officer
(218) 685-7344
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
10/15/2021
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