Contract Pharmacy Details

PROCARE PHARMACY, L.L.C.
DSH050471 PIH HEALTH GOOD SAMARITAN HOSPITAL

Covered Entity Details

Entity Name

PIH HEALTH GOOD SAMARITAN HOSPITAL

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH050471

Entity Address

1225 Wilshire Blvd
LOS ANGELES, CA 90017-2395

Medicare Provider Number

050471

Participating Start Date

7/1/2008

Last Recertification Date

8/27/2024

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

10/26/2021

Contract Begin Date

1/1/2022

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

9/15/2022
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

JAMES R. WEST, PRESIDENT and CEO
(562) 698-0811 Ext: 12413

Contract Pharmacy Representative

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

Signed By Date

10/26/2021

340B Drug Pricing Program Database