Contract Pharmacy Details

PROCARE PHARMACY, L.L.C.
DSH330125 ROCHESTER GENERAL HOSPITAL

Covered Entity Details

Entity Name

ROCHESTER GENERAL HOSPITAL

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH330125

Entity Address

1425 PORTLAND AVENUE
ROCHESTER, NY 14621

Medicare Provider Number

330125

Participating Start Date

10/1/2019

Last Recertification Date

8/15/2024

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

Hugh Thomas, Executive Vice President, Chief Administrative Officer
(585) 922-4941

Contract Pharmacy Representative

CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782

Signed By Date

10/15/2021

340B Drug Pricing Program Database