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PROCARE PHARMACY, L.L.C.
DSH520139 West Allis Memorial Hospital Inc. DBA Aurora West Allis Medical Center
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Covered Entity Details
Entity Name
West Allis Memorial Hospital Inc. DBA Aurora West Allis Medical Center
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH520139
Entity Address
8901 West Lincoln Avenue
West Allis, WI 53227
Medicare Provider Number
520139
Participating Start Date
7/1/2014
Last Recertification Date
8/14/2024
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
Nan Nelson, SVP-Finance
(414) 378-4765
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
10/15/2021
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