Contract Pharmacy Details

PROCARE PHARMACY, L.L.C.
DSH140182 ADVOCATE NORTH SIDE HEALTH NETWORK

Covered Entity Details

Entity Name

ADVOCATE NORTH SIDE HEALTH NETWORK

Subdivision Name

DBA ADVOCATE ILLINOIS MASONIC MEDICAL CENTER (AIMMC)

Type

Disproportionate Share Hospital

340B ID

DSH140182

Entity Address

836 West Wellington Ave.
CHICAGO, IL 60657

Medicare Provider Number

140182

Participating Start Date

10/27/2005

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

340B Drug Pricing Program Database